Ejike J Chiaka, Humbert S, Bahjri K, Mathur M
Department of Pediatrics, School of Medicine, Loma Linda University, School of Medicine Loma Linda, California 92354, USA.
Acta Clin Belg. 2007;62 Suppl 1:141-8.
Abdominal compartment syndrome (ACS) is a problem across all critical care scenarios and is associated with a high mortality. It has not been well described in pediatric populations.
To describe the occurrence of ACS in a subset of critically ill pediatric patients and determine its effects on mortality and length of pediatric intensive care stay (PICU LOS). We also aimed to find predictors of mortality and development of ACS.
25 bed tertiary pediatric intensive care unit.
Patients less than 50 kg on mechanical ventilation and a urethral catheter.
Intra-abdominal pressures (IAP) were monitored using the intra-vesical technique. ACS was defined as IAP of >12mmHg associated with new organ dysfunction or failure. Demographics, physiologic measures of organ dysfunction, PICU LOS and mortality were monitored.
14 (4.7%) of 294 eligible patients had ACS. Mortality was 50% among those with ACS versus 8.2% without (p<.001). PICU LOS stay did not differ between groups. No difference in mortality or PICU LOS was seen in primary versus secondaryACS or in patients who underwent abdominal decompression compared to those without decompression. IAP and ACS were independent predictors of mortality (odds ratio 1.53, 95% CI, 1.17- 1.99 and 9.09, 95% CI, 1.07 - 76.84) respectively. IAP and a PRISM score of >17 were predictive of developing ACS.
ACS is a clinical problem that increases the risk of mortality in critically ill children. IAP and PRISM scores may help identify children likely to develop ACS.
腹腔间隔室综合征（ACS）在所有重症监护情况下都是一个问题，且与高死亡率相关。在儿科人群中对其描述尚不充分。
描述重症儿科患者亚组中ACS的发生情况，并确定其对死亡率和儿科重症监护病房住院时间（PICU LOS）的影响。我们还旨在找出死亡率和ACS发生的预测因素。
拥有25张床位的三级儿科重症监护病房。
体重小于50kg且正在接受机械通气和留置导尿管的患者。
采用膀胱内技术监测腹内压（IAP）。ACS定义为IAP>12mmHg且伴有新的器官功能障碍或衰竭。监测人口统计学、器官功能障碍的生理指标、PICU LOS和死亡率。
294例符合条件的患者中有14例（4.7%）发生ACS。ACS患者的死亡率为50%，无ACS患者为8.2%（p<0.001）。两组间PICU LOS无差异。原发性与继发性ACS患者之间，或接受腹部减压与未接受减压的患者之间，死亡率和PICU LOS均无差异。IAP和ACS分别是死亡率的独立预测因素（优势比1.53，95%CI，1.17 - 1.99；以及9.09，95%CI，1.07 - 76.84）。IAP和PRISM评分>17可预测ACS的发生。
ACS是一个临床问题，会增加重症儿童的死亡风险。IAP和PRISM评分可能有助于识别可能发生ACS的儿童。
