Early screening to identify patients at risk of developing intra‐abdominal hypertension and abdominal compartment syndrome

Background To develop a screening tool to identify patients at risk of developing intra‐abdominal hypertension ( IAH ) and abdominal compartment syndrome ( ACS ) within 24 h of a patient's admission to intensive care unit ( ICU ). Methods Prospective, observational study of 403 consecutively enrolled patients with an indwelling catheter, admitted to a mixed medical‐surgical ICU in a tertiary referral, university hospital. Intra‐abdominal pressure was measured at least twice daily and IAH and ACS defined as per consensus definitions. Results Thirty‐nine per cent of patients developed IAH and 2% developed ACS . Abdominal distension, hemoperitoneum/pneumoperitoneum/intra‐peritoneal fluid collection, obesity, intravenous fluid received > 2.3 l, abbreviated Sequential O rgan F ailure A ssessment score > 4 points and lactate > 1.4 mmol/l were identified as independent predictors of IAH upon admission to ICU . The presence of three or more of these risk factors at admission identified patients that would develop IAH with a sensitivity of 75% and a specificity of 76%, the development of grades II , III and IV IAH with a sensitivity of 91% and a specificity of 62%. Patients that developed IAH required a significantly longer duration of mechanical ventilation and ICU care. Patients that developed grades II–IV IAH had a significantly higher rate of ICU mortality. Conclusion IAH is a common clinical entity in the intensive care setting that is associated with morbidity and mortality. A screening tool, based on data readily available within a patient's first 24 h in ICU , was developed and effectively identified patients that required intra‐abdominal pressure monitoring.