Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome - A sub-analysis of a prospective cohort.

Autor: Regli A; Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The Notre Dame University, Fremantle, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia. Electronic address: adrian.regli@health.wa.gov., Reintam Blaser A; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland., De Keulenaer B; Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; School of Surgery, The University of Western Australia, Perth, WA, Australia., Starkopf J; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia., Kimball E; Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States., Malbrain MLNG; Faculty of Engineering, Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium; International Fluid Academy, Lovenjoel, Belgium., Van Heerden PV; General Intensive Care Unit, Hadassah Hospital, Jerusalem, Israel., Davis WA; Medical School, The University of Western Australia, Perth, WA, Australia., Palermo A; Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia., Dabrowski W; First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland., Siwicka-Gieroba D; First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland., Barud M; First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland., Grigoras I; Grigore T. Popa, University of Medicine and Pharmacy, Iasi, Romania; Regional Institute of Oncology, Iasi, Romania., Ristescu AI; Grigore T. Popa, University of Medicine and Pharmacy, Iasi, Romania; Regional Institute of Oncology, Iasi, Romania., Blejusca A; Regional Institute of Oncology, Iasi, Romania., Tamme K; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia., Maddison L; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia., Kirsimägi Ü; Department of Surgery, Tartu University Hospital, Tartu, Estonia., Litvin A; Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia., Kazlova A; Department of Intensive Care Medicine, Regional Clinical Hospital, Gomel, Belarus., Filatau A; Department of Intensive Care Medicine, Regional Clinical Hospital, Gomel, Belarus., Pracca F; Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay., Sosa G; Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay., Santos MD; Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay., Kirov M; Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia., Smetkin A; Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia., Ilyina Y; Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia., Gilsdorf D; Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States., Ordoñez CA; Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili - Universidad del Valle, Cali, Colombia., Caicedo Y; Centro de Investigaciones Clínicas (CIC), Fundacion Valle del Lili, Cali, Colombia., Greiffenstein P; Louisiana State University Health Sciences Center, New Orleans, United States., Morgan MM; Louisiana State University Health Sciences Center, New Orleans, United States; UC Health Memorial Hospital Central, Colorado Springs, California, United States., Bodnar Z; University Hospital of Torrevieja, Torrevieja, Spain; Letterkenny University Hospital, Letterkenny, Ireland., Tidrenczel E; University Hospital of Torrevieja, Torrevieja, Spain; Killybegs Family Health Centre, Killybegs, Ireland., Oliveira G; Polyvalent Intensive Care Unit, Hospitalar Center Tondela-Viseu, Tondela-Viseu, Portugal., Albuquerque A; Polyvalent Intensive Care Unit, Hospitalar Center Tondela-Viseu, Tondela-Viseu, Portugal., Pereira BM; Postgraduate and Research Division, Masters Program in Health Applied Sciences, Vassouras University, Vassouras, RJ, Brazil; Grupo Surgical, Campinas, SP, Brazil; Terzius Institute of Education, Campinas, SP, Brazil.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2021 Aug; Vol. 64, pp. 165-172. Date of Electronic Publication: 2021 Apr 17.
DOI: 10.1016/j.jcrc.2021.04.009
Abstrakt: Purpose: To assess whether the combination of intra-abdominal hypertension (IAH, intra-abdominal pressure ≥ 12 mmHg) and hypoxic respiratory failure (HRF, PaO2/FiO2 ratio < 300 mmHg) in patients receiving invasive ventilation is an independent risk factor for 90- and 28-day mortality as well as ICU- and ventilation-free days.
Methods: Mechanically ventilated patients who had blood gas analyses performed and intra-abdominal pressure measured, were included from a prospective cohort. Subgroups were defined by the absence (Group 1) or the presence of either IAH (Group 2) or HRF (Group 3) or both (Group 4). Mixed-effects regression analysis was performed.
Results: Ninety-day mortality increased from 16% (Group 1, n = 50) to 30% (Group 2, n = 20) and 27% (Group 3, n = 100) to 49% (Group 4, n = 142), log-rank test p < 0.001. The combination of IAH and HRF was associated with increased 90- and 28-day mortality as well as with fewer ICU- and ventilation-free days. The association with 90-day mortality was no longer present after adjustment for independent variables. However, the association with 28-day mortality, ICU- and ventilation-free days persisted after adjusting for independent variables.
Conclusions: In our sub-analysis, the combination of IAH and HRF was not independently associated with 90-day mortality but independently increased the odds of 28-day mortality, and reduced the number of ICU- and ventilation-free days.
Competing Interests: Declaration of Competing Interest ARB received honoraria for advisory board meetings or speaker fees from Nestlé and Fresenius and Nutricia and is a member of executive committee of the Abdominal Compartment Society (WSACS). University of Tartu received study grant from Fresenius. MLNGM is co-founder, past-President and current Treasurer of WSACS (The Abdominal Compartment Society, http://www.wsacs.org), he is member of the medical advisory Board of Pulsion Medical Systems (part of Getinge group) and Serenno Medical, and consults for ConvaTec, Acelity, Spiegelberg, and Holtech Medical. He is co-founder of the International Fluid Academy (IFA). The IFA is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law. No other authors have any conflict of interest to report.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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