Daugherty Elizabeth L, Taichman Darren, Hansen-Flaschen John, Fuchs Barry D
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Intensive Care Med. 2007 Sep-Oct;22(5):294-9. doi: 10.1177/0885066607305247.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been well described in surgical patients. Large-volume resuscitation is thought to be a risk factor for IAH/ACS in this group. However, little is known of the incidence of IAH/ACS in critically ill medical patients. The authors aim to ascertain the incidence of ACS in critically ill medical patients receiving large-volume resuscitation. Over an 8-month study period, the authors performed a prospective cohort study of medical intensive care unit (ICU) patients with a minimum net positive fluid balance of 5 L within the preceding 24 hours. The primary outcome of interest is the development of ACS, defined as an intra-abdominal pressure (IAP) > or = 20 mm Hg associated with new organ dysfunction. IAP was measured by transducing bladder pressure and was recorded along with fluid balance at enrollment and every 12 hours thereafter up to 96 hours. The setting is a medical ICU at a major university hospital. Of the 468 medical ICU admissions screened, 40 (8.5%) were identified who met the 24-hour fluid balance inclusion criterion. Upon enrollment, this cohort had a mean Acute Physiology And Chronic Health Evaluation II score of 23 and a median positive fluid balance of 6.9 L. Thirty-four of the 40 study patients (85%) had intra-abdominal hypertension (IAP > or = 12 mm Hg). During the study period, 13 of the 40 (33%) patients developed IAP > or = 20 mm Hg and 10 (25%) met the criteria for ACS. None underwent laparotomy. ACS is frequently found in critically ill medical patients receiving large-volume resuscitation. The clinical significance of this finding remains unclear. However, routine monitoring of IAP should be considered in medical patients with a 5-L net positive fluid balance in 24 hours. Future studies are warranted to evaluate clinical outcomes of medical patients with ACS and risk factors for its development.
腹内高压（IAH）和腹腔间隔室综合征（ACS）在外科患者中已有充分描述。大量液体复苏被认为是该组患者发生IAH/ACS的一个危险因素。然而，对于重症内科患者中IAH/ACS的发生率知之甚少。作者旨在确定接受大量液体复苏的重症内科患者中ACS的发生率。在为期8个月的研究期间，作者对医学重症监护病房（ICU）的患者进行了一项前瞻性队列研究，这些患者在之前24小时内的净液体平衡至少为5升。感兴趣的主要结局是ACS的发生，定义为腹内压（IAP）≥20 mmHg且伴有新的器官功能障碍。通过测量膀胱压力来测定IAP，并在入组时以及此后每12小时记录一次液体平衡，直至96小时。研究地点是一所大型大学医院的医学ICU。在筛查的468例医学ICU入院患者中，有40例（8.5%）符合24小时液体平衡纳入标准。入组时，该队列的急性生理与慢性健康状况评估II（APACHE II）评分平均为23分，液体正平衡中位数为6.9升。40例研究患者中有34例（85%）存在腹内高压（IAP≥12 mmHg）。在研究期间，40例患者中有13例（33%）的IAP≥20 mmHg，10例（25%）符合ACS标准。无一例接受剖腹手术。在接受大量液体复苏的重症内科患者中经常发现ACS。这一发现的临床意义尚不清楚。然而，对于24小时内净液体正平衡达5升的内科患者，应考虑常规监测IAP。有必要进行进一步研究以评估患有ACS的内科患者的临床结局及其发生的危险因素。
