Department of Intensive Care, Liverpool Hospital, Sydney, Australia.
South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
Acta Anaesthesiol Scand. 2018 Nov;62(10):1421-1427. doi: 10.1111/aas.13211. Epub 2018 Jul 5.
Elevated intra-abdominal pressure (IAP) is a common occurrence in mechanically ventilated patients in the intensive care unit (ICU). This study was undertaken to determine the relationship between IAP, pulmonary compliance and the duration of mechanical ventilation.
A prospective study of 220 consecutively enrolled mechanically ventilated patients admitted to a mixed surgical-medical ICU in a tertiary referral hospital. The IAP was measured at least twice daily, benchmarked against consensus guidelines. Dynamic pulmonary compliance was calculated together with admission Acute Physiology and Chronic Health Evaluation (APACHE III) score and daily Sequential Organ Failure Assessment (SOFA) score.
No relationship between highest IAP for the day and pulmonary compliance (P = 0.61) was found. For each 5 mm Hg increase in IAP, the risk of remaining intubated increased 19% (HR = 1.19, 95% CI: 0.98-1.44); for each standard deviation increase in SOFA score (3.7 points), the risk of remaining intubated increased by 14% (HR = 1.14, 95% CI: 0.98-1.33); and for each 1 L increase in fluid balance, the risk of remaining intubated increased by 11% (HR = 1.11, 95% CI: 1.04-1.19). A nomogram was developed to predict the probability of extubation based on daily highest IAP for the day, SOFA score and fluid balance.
IAPs did not correlate with pulmonary compliance in critically ill patients. Increased IAP was associated with a longer duration of mechanical ventilation. A nomogram integrating daily IAP, SOFA score and fluid balance may be used to predict the duration of mechanical ventilation.
在重症监护病房（ICU）中，机械通气患者常出现腹腔内压（IAP）升高。本研究旨在确定 IAP、肺顺应性与机械通气时间之间的关系。
对一家三级转诊医院综合外科-内科 ICU 中连续纳入的 220 例机械通气患者进行前瞻性研究。IAP 每日至少测量 2 次，以共识指南为基准。计算动态肺顺应性，同时计算入院时急性生理学和慢性健康评估（APACHE III）评分和每日序贯器官衰竭评估（SOFA）评分。
当日最高 IAP 与肺顺应性之间无相关性（P=0.61）。IAP 每增加 5mmHg，插管保留的风险增加 19%（HR=1.19，95%CI：0.98-1.44）；SOFA 评分每增加 3.7 分（1 个标准差），插管保留的风险增加 14%（HR=1.14，95%CI：0.98-1.33）；液体平衡每增加 1L，插管保留的风险增加 11%（HR=1.11，95%CI：1.04-1.19）。基于每日最高 IAP、SOFA 评分和液体平衡，制定了一个预测拔管概率的列线图。
危重症患者的 IAP 与肺顺应性无相关性。IAP 升高与机械通气时间延长相关。整合每日 IAP、SOFA 评分和液体平衡的列线图可用于预测机械通气时间。
