Thabet Farah Chedly, Bougmiza Iheb Mohamed, Chehab May Said, Bafaqih Hind Ali, AlMohaimeed Sulaiman Abdulkareem, Malbrain Manu L N G
Division of Pediatric Intensive Care, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
Department of Family and Community Medicine, Faculty of Medicine of Sousse, Sousse, Tunisia.
J Intensive Care Med. 2016 Jul;31(6):403-8. doi: 10.1177/0885066615583645. Epub 2015 Apr 28.
To assess the incidence, risk factors, and outcomes of intra-abdominal hypertension (IAH) in a pediatric intensive care unit (PICU).
Prospective cohort study from January 2011 to January 2013. All children consecutively admitted to the PICU, staying more than 24 hours and requiring bladder catheterization, were included in the study. On admission, demographic data and risk factors for IAH were studied. The intra-abdominal pressure was measured every 6 hours through a bladder catheter until discharge, death, or removal of the catheter.
Of the 175 patients, 22 (12.6%) had IAH and 7 (4%) had abdominal compartment syndrome during the intensive care unit (ICU) stay. The independent risk factors associated with IAH were the presence of abdominal distension (odds ratio [OR] 7.1; 95% confidence interval [CI], 2.6-19.9; P < .0001) and a plateau pressure of more than 30 cm H2O (OR 6.42; 95% CI, 2.13-19.36; P = .01). The presence of IAH was associated with higher mortality (40.9% vs 15.6%; P = .01) and prolonged ICU stay (19.5 [3-97] vs 8 [1-104] days, OR 1.02; 95% CI, 1.00-1.04; P = .02). Thirty-three (18.8%) patients died in the ICU, and IAH was an independent risk factor for mortality (OR 6.98; 95% CI, 1.75-27.86; P = .006).
Intra-abdominal hypertension does occur in about 13% of the critically ill children, albeit less frequently than adult patients, probably related to a better compliance of the abdominal wall. The presence of abdominal distension and a plateau pressure of more than 30 cm H2O was found to be independent predictors of IAH. Children with IAH had higher mortality rate and more prolonged ICU stay.
评估儿科重症监护病房（PICU）内腹腔内高压（IAH）的发生率、危险因素及预后。
2011年1月至2013年1月的前瞻性队列研究。所有连续入住PICU、住院时间超过24小时且需要留置膀胱导管的儿童均纳入研究。入院时，研究人口统计学数据及IAH的危险因素。通过膀胱导管每6小时测量一次腹腔内压力，直至出院、死亡或拔除导管。
175例患者中，22例（12.6%）在重症监护病房（ICU）住院期间发生IAH，7例（4%）发生腹腔间隔室综合征。与IAH相关的独立危险因素为腹胀（比值比[OR]7.1；95%置信区间[CI]，2.6 - 19.9；P <.0001）和平台压超过30 cm H2O（OR 6.42；95% CI，2.13 - 19.36；P =.01）。IAH的存在与较高的死亡率（40.9%对15.6%；P =.01）和ICU住院时间延长（19.5[3 - 97]天对8[1 - 104]天，OR 1.02；95% CI，1.00 - 1.04；P =.02）相关。33例（18.8%）患者在ICU死亡，IAH是死亡的独立危险因素（OR 6.98；95% CI，1.75 - 27.86；P =.006）。
腹腔内高压在约13%的危重症儿童中确实会发生，尽管比成年患者少见，这可能与腹壁更好的顺应性有关。腹胀和平台压超过30 cm H2O被发现是IAH的独立预测因素。患有IAH的儿童死亡率更高，ICU住院时间更长。
