Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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Risk factors for death among critically ill patients with acute renal failure

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000500004 ◽

2006 ◽

Vol 124 (5) ◽

pp. 257-263 ◽

Cited By ~ 15

Author(s):

Geraldo Bezerra da Silva Júnior ◽

Elizabeth De Francesco Daher ◽

Rosa Maria Salani Mota ◽

Francisco Albano Menezes

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Mechanical Ventilation ◽

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Liver Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Urine Volume

CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003). CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.

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Polynomial Regression Model Analysis of Abdominal Wall Tension and Intra-abdominal Pressure in Critically ill Patients

10.21203/rs.3.rs-711781/v1 ◽

2021 ◽

Author(s):

Hao Tang ◽

Dongchu Zhao ◽

Chuan Zhang ◽

Xiaoying Huang ◽

Dong Liu ◽

...

Keyword(s):

Risk Factors ◽

Regression Model ◽

Critically Ill ◽

Critically Ill Patients ◽

Polynomial Regression ◽

Prognostic Indicators ◽

Wall Tension ◽

Abdominal Hypertension ◽

Abdominal Compliance ◽

Polynomial Regression Model

Abstract BackgroundAbdominal wall tension (AWT) plays an important role in the pathogenesis of abdominal compliance (AC). This study uses a polynomial regression model to analyze the correlation between intra-vesical pressure(IVP) and AWT in critically ill patients and provides new ideas for the diagnosis and treatment of critically ill patients with intra-abdominal hypertension（IAH）.MethodsA retrospective analysis was conducted in critically ill patients who met the inclusion criteria and were admitted to the Department of intensive care unit of Daping Hospital of Army Medical University from March 14, 2019, to May 23, 2020. According to the IVP on the first day of ICU admission and death within 28 days, the patients were divided into the IAH group (IVP ≥12 mmHg), the non-IAH group, the survival group and the nonsurvival group. The demographic and clinical data, prognostic indicators, AWT and IVP on days 1-7 after entering the ICU, IAH risk factors, and 28-day death risk factors were collected.ResultsA total of 100 patients were enrolled, with an average age of 45.59±11.4 years. There were 55 males (55%), 30 patients from departments of internal medicine (30%), 43 patients from surgery departments (43%), and 27 trauma patients (27%). In the IAH group, there were 50 patients (29 males, 58%), with an average age of 45.28±12.27 years; there were 50 patients (26 males, 52%) in the non-IAH group, with an average age of 45.90±10.58 years. The IVP on the 1st day and the average IVP within 7 days of the IAH group was 18.99（17.52，20.77）mmHg and 19.43（16.87，22.25）mmHg, respectively, which was higher than that of the non-IAH group [ 6.14（3.48，8.70）mmHg, 6.66（2.74，9.08）mmHg], p＜0.001. The AWT on the 1st day and the average AWT within 7 days of the IAH group was 2.89±0.32 N/mm and 2.82±0.46 N/mm, respectively, which was higher than that of the non-IAH group [(2.45±0.29)N/mm,(2.43±0.39)N/mm],p＜0.001.The polynomial regression models showed that the average AWT and IVP on the 1st day and within 7 days were AWTday1 = -2.450×10-3IVP2+9.695×10-2 IVP+2.046，r=0.667（p＜0.0001），and AWTmean = -2.293×10-3IVP2+9.273×10-2 IVP+2.081, respectively. The logistic regression analysis showed that AWTday1 of 2.73-2.97 N/mm increased the patient's 28-day mortality risk (OR: 6.834; 95%: 1.105-42.266, p=0.010).ConclusionsThere is a nonlinear correlation between AWT and IVP in critically ill patients, and a high AWT may indicate poor prognosis.

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Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Nutrients ◽

10.3390/nu11112616 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2616

Author(s):

M Bordejé ◽

Juan Montejo ◽

M Mateu ◽

Manuel Solera ◽

Jose Acosta ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Urinary Catheter ◽

Abdominal Pressure ◽

Icu Patients ◽

Group A ◽

Group B ◽

Low Sensitivity

To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications; to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p < 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p < 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.

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Incidence, Risk Factors and Outcome Associations of Intra-Abdominal Hypertension in Critically Ill Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x1204000107 ◽

2012 ◽

Vol 40 (1) ◽

pp. 79-89 ◽

Cited By ~ 51

Author(s):

I. B. Kim ◽

J. Prowle ◽

I. Baldwin ◽

R. Bellomo

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Abdominal Hypertension ◽

Incidence Risk

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Relationship between intra-abdominal pressure and indocyanine green plasma disappearance rate: hepatic perfusion may be impaired in critically ill patients with intra-abdominal hypertension

Annals of Intensive Care ◽

10.1186/2110-5820-2-s1-s19 ◽

2012 ◽

Vol 2 (Suppl 1) ◽

pp. S19 ◽

Cited By ~ 23

Author(s):

Manu LNG Malbrain ◽

Dries Viaene ◽

Andreas Kortgen ◽

Inneke De laet ◽

Hilde Dits ◽

...

Keyword(s):

Indocyanine Green ◽

Critically Ill ◽

Critically Ill Patients ◽

Abdominal Pressure ◽

Disappearance Rate ◽

Plasma Disappearance Rate ◽

Hepatic Perfusion ◽

Abdominal Hypertension

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Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review

Journal of Intensive Care Medicine ◽

10.1177/0885066619892225 ◽

2019 ◽

Vol 36 (2) ◽

pp. 197-202 ◽

Cited By ~ 1

Author(s):

Zaid Khot ◽

Patrick B. Murphy ◽

Nathalie Sela ◽

Neil G. Parry ◽

Kelly Vogt ◽

...

Keyword(s):

Compartment Syndrome ◽

Critically Ill ◽

Abdominal Compartment Syndrome ◽

Critically Ill Patients ◽

Data Extraction ◽

Common Finding ◽

Abdominal Pressure ◽

Abdominal Hypertension ◽

Definition Of ◽

Abdominal Compartment

Objective: To determine the contemporary prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome in critically ill patients. Data Sources: Medline, Embase, and Central databases. Study Selection: Studies reporting on the prevalence of IAH in consecutively admitted critically ill patients using the World Society of Abdominal Compartment Syndrome (WSACS) consensus guidelines for intra-abdominal pressure (IAP) measurement. Data Extraction: Duplicate independent review and data abstraction. Data Synthesis: The search identified 2428 titles with 6 eligible studies (n = 1965). Reported prevalence ranged from 30% to 49%. Despite abiding by the WSACS guidelines for IAP measurement, studies varied in their definition of IAH, frequency and duration of IAP measurement, and reporting of outcomes. Three of 6 studies reported that IAH, especially at higher grades, was an independent predictor of mortality. Conclusions: Intra-abdominal hypertension is a common finding in critically ill patients and may be associated with increased mortality, especially at higher grades. Further prospective research is required to examine the effect of screening and treatment of IAH on patient outcomes.

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A Clinical Study of AWT Measurement and Polynomial Regression Model Analysis in Critically Ill Patients

10.21203/rs.3.rs-516211/v1 ◽

2021 ◽

Author(s):

Hao Tang ◽

Dongchu Zhao ◽

Chuan Zhang ◽

Xiaoying Huang ◽

Dong Liu ◽

...

Keyword(s):

Risk Factors ◽

Regression Model ◽

Critically Ill ◽

Critically Ill Patients ◽

Polynomial Regression ◽

Prognostic Indicators ◽

Survival Group ◽

Abdominal Hypertension ◽

Polynomial Regression Models ◽

Polynomial Regression Model

Abstract Objective: In this study, a new measurement device was used to measure the AWT in critically ill patients and a polynomial regression model was applied to analyze the correlation between intra-abdominal hypertension (IAH) and AWT in critically ill patients.Methods: A retrospective analysis was conducted in critically ill patients who were admitted to the Department of Critical Care Medicine of Daping Hospital of Army Medical University from August 30, 2018, to June 30, 2020. According to the intravesical pressure (IVP) on the first day of ICU admission and death within 28 days, the patients were divided into the IAH group (IVP ≥12 mmHg), the non-IAH group, the survival group and the nonsurvival group. The demographic and clinical data, prognostic indicators, AWT and IVP on days 1-7 after entering the ICU, IAH risk factors, and 28-day death risk factors were collected.Results: The AWT on the 1st and mean 7th day of the IAH group was (2.89±0.32)N/mm and (2.82±0.46) N/mm, respectively, which was higher than that of the non-IAH group [ (2.45±0.29) N/mm, (2.43±0.39) N/mm], p＜0.001. The average IVP on the 1st and mean 7th day of all patients were 12.78 (6.14, 18.99) and 11.49 (6.66, 19.43) mmHg, and the AWT on the 1st and mean 7th days were (2.75±0.38) and (2.75±0.47) N/mm, respectively, with significant differences (p< 0.0001). The polynomial regression models showed that the average AWT and IVP on the 1st and mean 7th were AWTday1=-2.450×10-3, IVP2+9.695×10-2 IVP+2.046，r=0.667（p＜0.0001），and AWTmean=-2.293×10-3, IVP2+9.273×10-2 IVP+2.081, respectively. The logistic regression analysis showed that AWTday1 2.73-2.97N/mm increased the patient's 28-day mortality risk (OR: 6.834; 95%: 1.105-42.266, p=0.010).Conclusion: There is a nonlinear correlation between AWT and IVP in critically ill patients, and a high AWT may indicate poor prognosis.

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Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

10.21203/rs.3.rs-23662/v1 ◽

2020 ◽

Author(s):

Ademar Takahama ◽

Vitoria Iaros de Sousa ◽

Elisa Emi Tanaka ◽

Evelise Ono ◽

Fernanda Akemi Nakanishi Ito ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Physical Examination ◽

Critically Ill ◽

Critically Ill Patients ◽

Cross Sectional Study ◽

Ventilator Associated Pneumonia ◽

Cross Sectional ◽

Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

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