The Impact of Abdominal Perfusion Pressure on Morbidity and Mortality in Critically Ill Patients with Multiorgan Dysfunction
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- Category: Vol. 84, December 2016
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The Impact of Abdominal Perfusion Pressure on Morbidity and Mortality in Critically Ill Patients with Multiorgan Dysfunction, HATEM H. AL-ATROUSH, NASHWA ABED, AMNA METWALLY, MOHAMED AFIFI and MAYADA M. HUSSEIN
Abstract
Background: Hemodynamic monitoring is the core prin-ciple in all Intensive Care Units, with ongrowing and sophis-ticated methods developing all the time to accurately measure it. Abdominal Perfusion Pressure (APP) is a new concept, easily obtainable parameter, defined as the difference between mean arterial pressure (which is the important parameter of tissue perfusion) and the Intra Abdominal Pressure (IAP) and it can reflect the abdominal compartment hemodynamics. IAP may oppose arterial inflow to visceral organs and may have direct pressure effect on them affecting their function. It can falsely elevate the central venous pressure and impede the venous return and be transmitted to other compartments (thorax and intracranial) causing increased pressures and deleterious effect.
Patients and Methods: 106 MODS patients were included in the study, routine laboratory investigations and vital signs were recorded and APP was calculated daily for the first three days.
Results: The APP on admission was negatively correlated with APACHE II and SOFA (r=–0.350, –0.501 and p<0.001, 0.001 respectively). Low APP was associated with increased mortality (85.4±16.5 vs 77.9±17.5 p 0.06). SOFA and the presence IAH in the first three days were the significant predictors for ICU mortality.
Conclusion: Presence of IAH is associated with increased mortality and Low APP is associated with increased morbidity and mortality.
Measures should be recommended to diagnose, prevent, monitor and manage the problem.