腹腔内高压、液体平衡与原位肝移植术后不良结局
Intra-abdominal hypertension, fluid balance, and adverse outcomes after orthotopic liver transplantation.
机构信息
Intensive Care Division, FAMERP Medical School and Hospital de Base, São Jose do Rio Preto, SP, Brazil.
Critical Care Medicine, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Surgical Critical Care Medicine, Pro-Cardiaco Hospital, Rio de Janeiro, RJ, Brazil.
出版信息
J Crit Care. 2021 Apr;62:271-275. doi: 10.1016/j.jcrc.2020.12.021. Epub 2020 Dec 26.
BACKGROUND
Intra-abdominal hypertension (IAH) is frequently encountered in critically ill surgical patients. We aimed to evaluate the incidence of IAH after orthotopic liver transplant (OLT) and its impact on organ function, hospital length-of-stay (LOS), and death.
METHODS
This prospective, observational, cohort study evaluated consecutive adult patients admitted in the ICU after undergoing OLT. Intra-abdominal pressure (IAP) was measured every 4-6 h for 3 days. Worsening IAP was defined as a gradual increase in IAP over a period of time. Daily fluid balance was the daily sum of all intakes minus the output.
RESULTS
IAH was observed in 48% of the patients within the first 3 days after ICU admission, while ACS was diagnosed in 15%. Patients with IAH had a higher positive fluid balance at day 1 (1764 mL [812-2733 mL] vs. 1301 mL [241-1904 mL], p = 0.025). Worsening IAH was associated with fewer days free of organ dysfunction. IAH within 72 h after ICU admission was independently associated with a composite outcome of death or a longer ICU LOS (odds ratio 2.9; CI 95% 1.02-8.25, p = 0.043).
CONCLUSION
After OLT, nearly half of the patients presented IAH, that was associated with unfavorable outcomes.
背景
腹腔内高压（IAH）在重症外科患者中经常发生。我们旨在评估原位肝移植（OLT）后 IAH 的发生率及其对器官功能、住院时间（LOS）和死亡的影响。
方法
这项前瞻性、观察性、队列研究评估了连续接受 OLT 后入住 ICU 的成年患者。每隔 4-6 小时测量一次 IAP，持续 3 天。逐渐升高的 IAP 定义为在一段时间内 IAP 的逐渐增加。每日液体平衡是所有摄入量减去输出量的每日总和。
结果
在 ICU 入院后的前 3 天内，48%的患者出现 IAH，而 ACS 的诊断率为 15%。有 IAH 的患者在第 1 天的正性液体平衡更高（1764 mL [812-2733 mL] vs. 1301 mL [241-1904 mL]，p = 0.025）。逐渐升高的 IAH 与无器官功能障碍天数减少相关。ICU 入院后 72 小时内的 IAH 与死亡或 ICU LOS 延长的复合结局独立相关（比值比 2.9；95%CI 1.02-8.25，p = 0.043）。
结论
OLT 后，近一半的患者出现 IAH，这与不良结局相关。
Zotero 插件