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Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock
- Source :
- Annals of Intensive Care
- Publication Year :
- 2012
- Publisher :
- Springer Science and Business Media LLC, 2012.
-
Abstract
- Background The importance of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) in cirrhotic patients with septic shock is not well studied. We evaluated the relationship between IAP and APP and outcomes of cirrhotic septic patients, and assessed the ability of these measures compared to other common resuscitative endpoints to differentiate survivors from nonsurvivors. Methods This study was a post hoc analysis of a randomized double-blind placebo-controlled trial in which mean arterial pressure (MAP), central venous oxygen saturation (ScvO2) and IAP were measured every 6 h in 61 cirrhotic septic patients admitted to the intensive care unit. APP was calculated as MAP - IAP. Intra-abdominal hypertension (IAH) was defined as mean IAP ≥ 12 mmHg, and abdominal hypoperfusion as mean APP < 60 mmHg. Measured outcomes included ICU and hospital mortality, need for renal replacement therapy (RRT) and ventilator- and vasopressor-free days. Results IAH prevalence on the first ICU day was 82%, and incidence in the first 7 days was 97%. Compared to patients with normal IAP, IAH patients had significantly higher ICU mortality (74.0% vs. 27.3%, p = 0.005), required more RRT (78.0% vs. 45.5%, p = 0.06) and had lower ventilator- and vasopressor-free days. On a multivariate logistic regression analysis, IAH was an independent predictor of both ICU mortality (odds ratio (OR), 12.20; 95% confidence interval (CI), 1.92 to 77.31, p = 0.008) and need for RRT (OR, 6.78; 95% CI, 1.29 to 35.70, p = 0.02). Using receiver operating characteristic curves, IAP (area under the curve (AUC) = 0.74, p = 0.004), APP (AUC = 0.71, p = 0.01), Acute Physiology and Chronic Health Evaluation II score (AUC = 0.71, p = 0.02), but not MAP, differentiated survivors from nonsurvivors. Conclusions IAH is highly prevalent in cirrhotic patients with septic shock and is associated with increased ICU morbidity and mortality.
- Subjects :
- medicine.medical_specialty
Septic shock
business.industry
Research
liver cirrhosis
Critical Care and Intensive Care Medicine
medicine.disease
Surgery
sepsis
Sepsis
compartment syndrome
ascites
Anesthesiology
Anesthesia
Ascites
mortality
medicine
septic shock
medicine.symptom
business
Perfusion
Intra abdominal pressure
Subjects
Details
- ISSN :
- 21105820
- Volume :
- 2
- Database :
- OpenAIRE
- Journal :
- Annals of Intensive Care
- Accession number :
- edsair.doi.dedup.....b3ddd889749e875030a028f1f6f7a448