Effect of Body Positioning on lntra-abdominal Pressure Measurement and Prognosis in Critically III Patients.pdfVIP

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Effect of Body Positioning on lntra-abdominal Pressure Measurement and Prognosis in Critically III Patients.pdf

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Effect of Body Positioning on lntra-abdominal Pressure Measurement and Prognosis in Critically III Patients.pdf

M inYi,YuBai,XiZhu cu，PekingUniversityThirdHospitalClinicalMedicine Abstract Background：Thecurrentliteraturesconfirm thewidespreadandrfequentdevelopmentofbothintraabdominalhypertension(IAH)andabdominal compartmentsyndromefACS1amongthecriticallyil】withasignificantassociatedriskoforganfailureandincreasedmortality．Theoccurrenceofintra abdominalhypertension (IAH)duringtheintensivecareunitstaywasanindependentoutcomepredictor．TheConsensusConferenceproposesintra— abdominalpressure(IAP)shouldbemeasuredinthecompletesupineposition，However,thesupinepositionofICUpatients(30。ofbedincrease) presentsasignificantriskfactorforventilator-associatedpneumonia．Thepotentialcontributionofheadofbed(HOB)positioninelevatingIAPshould beconsidered．Thepurposeofthisstudywastoevaluatetheeffectofbodypositioningonintra-abdominalpressuremeasurementandtheeffectoflAPat differentbodypositioningonprognosisincriticallyil1patients． M ethods：A prospective，cohort sutdytoinvestigatetheeffectofpatientpositioningonIAPandprognosiswasconductedoncriticallyillpatients admittedtoamedical—surgicalintensivecareunit(ICU)Onadmission，epidemiologicdataandriskfactorsforintra—abdominalhypertensionwere sutdied；then，dailymaximalintra-abdominalpressures(IAPmax)，abdominalperfusionpressure，filtrationgradient，AcutePhysiologyandChronicHealth Evaluation(APACHE)IIscoreandsequentialorganfailureassessment(SOFA)score，wereregistered．IAPswererecordedthroughabladdercatheter every4hrsinfirstday．IAPwasmeasuredinarangeofpatientHOB increasesfrom 0。to45。 Intra—abdominalhypertensionwasdefinedasIAP12mm Hg．AbdominalcompartmentsyndromewasdefinedasIAP20mm Hgpluslnew organfailure．M ainoutcomemeasurewashospitalmortality． Results：ThemainresultsofthissutdyarethehighincidenceofIAH f27．8％1inaprospectivecohort ofconsecutiveICU patients；asignificantand independentrelationshipbetweenIAPandHOBincreasesConsideringtheabsolutenumbersofIAP,thediffere