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n Southern African Journal of Critical Care - The effect of intra-abdominal hypertension on gastrointestinal function
Intra-abdominal hypertension (IAH) is a frequent occurrence in critically ill patients. Raised intra-abdominal pressure negatively affects gastro-intestinal (GI) function and may reduce the success of enteral nutrition support, which in turn is associated with adverse clinical outcomes.
To evaluate the impact of raised intra-abdominal pressure (IAP) on GI function and success of enteral nutrition support in an adult intensive care unit (ICU) population at risk of abdominal compartment syndrome (ACS).
In a prospective observational study, critically ill patients in whom the IAP was monitored routinely for clinical indications were assessed for GI symptoms, methods of nutrition support and enteral feeding success on a daily basis.
In total, data from 17 patients for a total of 98 patient days were included in the study. The mean IAP was 14.0 mmHg (standard deviation (SD) 3.7) on admission to the ICU. There were 10 patients with grade I, 2 with grade II and 2 with grade III IAH. Seven patients (41%) developed ACS. GI symptoms were common in patients with IAH, and days of IAH correlated positively with number of GI symptoms (r=0.85, p=0.000). Exclusive enteral feeding was possible on 32% of study days. There was a 12% incidence of enteral feeding intolerance and a 59% incidence of enteral feeding failure. Enteral feeding failure was not significantly associated with IAH (r=0.43, p=0.08), but was associated with number of GI symptoms (r=0.67, p=0.003). Days of IAH were positively associated with longer ICU stay (r=0.65, p=0.005), as was prevalence of IAH combined with concurrent GI symptoms (r=0.71, p=0.001). Days with IAH and multiple GI symptoms combined was associated with worse subsequent sequential organ failure assessment (SOFA) score (r=0.64, p=0.005). The worst SOFA score in those who died was significantly higher than that of survivors (11.7 (SD 3.05) v. 6.86 (SD 3.2), p=0.03), and was also significantly higher in those who developed ACS than in those who did not (10.9 (SD 2.5) v. 5.5 (SD 1.1), p=0.0005). The mortality rate was 17%, and only patients who developed ACS died.
Raised IAP was associated with poor GI function, enteral feed intolerance, prolonged hospital stay and death.
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