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Arruda Correia ML, Peixoto Filho FM, Gomes Júnior SC, Peixoto MVM. Effects of intra-abdominal hypertension on maternal-fetal outcomes in term pregnant women: A systematic review. PLoS One 2023; 18:e0280869. [PMID: 37368887 DOI: 10.1371/journal.pone.0280869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/10/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE To carry out a systematic review to assess the effects of intra-abdominal hypertension on maternal-fetal outcomes. METHODS The search was carried out between 28th June to 4th July 2022 on the Biblioteca Virtual em Saúde, Pubmed, Embase, Web of Science, and Cochrane databases. The study was registered in PROSPERO (CRD42020206526). The systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. To assess the methodological quality and control the risk of bias, New Castle was used. RESULTS A total of 6203 articles were found. Of these, 5 met the selection criteria for a full reading. The selected studies included a total of 271 pregnant women, of which 242 underwent elective cesarean section and measurement of intra-abdominal pressure via a bladder catheter. In both pregnant women groups, the lowest intra-abdominal pressure values were found in the supine position with left lateral tilt. Prepartum values in normotensive women with singleton pregnancy (7.3±1.3 to 14.1 ± 1 mmHg) were lower than in gestational hypertensive disorders (12.0±3.3 to 18.3±2.6 mmHg). In postpartum, the values decreased in both groups but were even lower in normotensive women (3.7±0.8 to 9.9 ± 2.6 mmHg vs 8.5 ± 3.6 to 13.6 ± 3.3 mmHg). The same was true for twin pregnancies. The Sequential Organ Failure Assessment index ranged from 0.6 (0.5) to 0.9 (0.7) in both groups of pregnant women. The placental malondialdehyde levels were statistically (p < 0.05) higher in pregnant women with pre-eclampsia (2.52±1.05) than normotensive (1.42±0.54). CONCLUSIONS Prepartum intra-abdominal pressure values in normotensive women were close or equal to intra-abdominal hypertension and compatible with gestational hypertensive disorders even in the postpartum period. IAP values were consistently lower in supine position with lateral tilt in both groups. Significant correlations were found between prematurity, low birth weight, pregnant women with hypertensive disorders, and increased intra-abdominal pressure. However, there was no significant association of dysfunction in any system in the relationship between intra-abdominal pressure and Sequential Organ Failure Assessment. Despite the higher malondialdehyde values in pregnant women with pre-eclampsia, the findings were inconclusive. Given the observed data on maternal and fetal outcomes, it would be recommended that intra-abdominal pressure measurements be standardized and used as a diagnostic tool during pregnancy. TRIAL REGISTRATION PROSPERO registration: October 9th, 2020, CRD42020206526.
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Pereira RA, Esteves AF, Cardoso FS, Perdigoto R, Marcelino P, Saliba F. Abdominal perfusion pressure in critically ill cirrhotic patients: a prospective observational study. Sci Rep 2023; 13:8550. [PMID: 37237113 DOI: 10.1038/s41598-023-34367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
In critical patients, abdominal perfusion pressure (APP) has been shown to correlate with outcome. However, data from cirrhotic patients is scarce. We aimed to characterize APP in critically ill cirrhotic patients, analyze the prevalence and risk factors of abdominal hypoperfusion (AhP) and outcomes. A prospective cohort study in a general ICU specialized in liver disease at a tertiary hospital center recruited consecutive cirrhotic patients between October 2016 and December 2021. The study included 101 patients, with a mean age of 57.2 (± 10.4) years and a female gender proportion of 23.5%. The most frequent etiology of cirrhosis was alcohol (51.0%), and the precipitant event was infection (37.3%). ACLF grade (1-3) distribution was 8.9%, 26.7% and 52.5%, respectively. A total of 1274 measurements presented a mean APP of 63 (± 15) mmHg. Baseline AhP prevalence was 47%, independently associated with paracentesis (aOR 4.81, CI 95% 1.46-15.8, p = 0.01) and ACLF grade (aOR 2.41, CI 95% 1.20-4.85, p = 0.01). Similarly, AhP during the first week (64%) had baseline ACLF grade (aOR 2.09, CI 95% 1.29-3.39, p = 0.003) as a risk factor. Independent risk factors for 28-day mortality were bilirubin (aOR 1.10, CI 95% 1.04-1.16, p < 0.001) and SAPS II score (aOR 1.07, CI 95% 1.03-1.11, p = 0.001). There was a high prevalence of AhP in critical cirrhotic patients. Abdominal hypoperfusion was independently associated with higher ACLF grade and baseline paracentesis. Risk factors for 28-day mortality included clinical severity and total bilirubin. The prevention and treatment of AhP in the high-risk cirrhotic patient is prudential.
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Affiliation(s)
- Rui Antunes Pereira
- Unidade de Cuidados Intensivos Polivalente 7 (UCIP7), Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
| | - André F Esteves
- Serviço de Medicina, Hospital Garcia de Orta, Almada, Portugal
| | - Filipe S Cardoso
- Unidade de Transplante, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Nova Medical School, Lisbon, Portugal
| | - Rui Perdigoto
- Unidade de Transplante, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Nova Medical School, Lisbon, Portugal
| | - Paulo Marcelino
- Unidade de Cuidados Intensivos Polivalente 4 (UCIP4), Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Hepato-Biliary center, Université Paris Saclay, INSERM unit Nº 1193, Villejuif, France
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Vasquez DN, Giannoni R, Salvatierra A, Cisneros K, Lafosse D, Escobar MF, Montenegro M, Juárez P, Visani L, Mandich V, Barrozo E, Kirschbaum M, Das Neves AV, Valenti MF, Canseco MC, Romero I, Macharé P, Marquez AK, Rodriguez E, Palacio C, Rapela L, Amillategui Scenna JM, Nuñez R, Torres S, González MA, Franconieri L, Nasner D, Okurzaty P, Plotnikow GA, Intile AD. Ventilatory Parameters in Obstetric Patients With COVID-19 and Impact of Delivery: A Multicenter Prospective Cohort Study. Chest 2023; 163:554-566. [PMID: 36257474 PMCID: PMC9573860 DOI: 10.1016/j.chest.2022.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Current evidence on obstetric patients requiring advanced ventilatory support and impact of delivery on ventilatory parameters is retrospective, scarce, and controversial. RESEARCH QUESTION What are the ventilatory parameters for obstetric patients with COVID-19 and how does delivery impact them? What are the risk factors for invasive mechanical ventilation (IMV) and for maternal, fetal, and neonatal mortality? STUDY DESIGN AND METHODS Prospective, multicenter, cohort study including pregnant and postpartum patients with COVID-19 requiring advanced ventilatory support in the ICU. RESULTS Ninety-one patients were admitted to 21 ICUs at 29.2 ± 4.9 weeks; 63 patients (69%) delivered in ICU. Maximal ventilatory support was as follows: IMV, 69 patients (76%); high-flow nasal cannula, 20 patients (22%); and noninvasive mechanical ventilation, 2 patients (2%). Sequential Organ Failure Assessment during the first 24 h (SOFA24) score was the only risk factor for IMV (OR, 1.97; 95% CI, 1.29-2.99; P = .001). Respiratory parameters at IMV onset for pregnant patients were: mean ± SD plateau pressure (PP), 24.3 ± 4.5 cm H2O; mean ± SD driving pressure (DP), 12.5 ± 3.3 cm H2O; median static compliance (SC), 31 mL/cm H2O (interquartile range [IQR], 26-40 mL/cm H2O); and median Pao2 to Fio2 ratio, 142 (IQR, 110-176). Respiratory parameters before (< 2 h) and after (≤ 2 h and 24 h) delivery were, respectively: mean ± SD PP, 25.6 ± 6.6 cm H2O, 24 ± 6.7 cm H2O, and 24.6 ± 5.2 cm H2O (P = .59); mean ± SD DP, 13.6 ± 4.2 cm H2O, 12.9 ± 3.9 cm H2O, and 13 ± 4.4 cm H2O (P = .69); median SC, 28 mL/cm H2O (IQR, 22.5-39 mL/cm H2O), 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O), and 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O; P = .058); and Pao2 to Fio2 ratio, 134 (IQR, 100-230), 168 (IQR, 136-185), and 192 (IQR, 132-232.5; P = .022). Reasons for induced delivery were as follows: maternal, 43 of 71 patients (60.5%); maternal and fetal, 21 of 71 patients (29.5%); and fetal, 7 of 71 patients (9.9%). Fourteen patients (22.2%) continued pregnancy after ICU discharge. Risk factors for maternal mortality were BMI (OR, 1.10; 95% CI, 1.006-1.204; P = .037) and comorbidities (OR, 4.15; 95% CI, 1.212-14.20; P = .023). Risk factors for fetal or neonatal mortality were gestational age at delivery (OR, 0.67; 95% CI, 0.52-0.86; P = .002) and SOFA24 score (OR, 1.53; 95% CI, 1.13-2.08; P = .006). INTERPRETATION Contrary to expectations, pregnant patient lung mechanics were similar to those of the general population with COVID-19 in the ICU. Delivery was induced mainly for maternal reasons, but did not change ventilatory parameters other than Pao2 to Fio2 ratio. SOFA24 score was the only risk factor for IMV. Maternal mortality was associated independently with BMI and comorbidities. Risk factors for fetal and neonatal mortality were SOFA24 score and gestational age at delivery.
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Affiliation(s)
| | - Roberto Giannoni
- Hospital Regional Ramón Carrillo, Santiago del Estero, Argentina
| | | | | | - Diego Lafosse
- Hospital Materno Infantil Dr. F Escardó, Tigre, Buenos Aires, Argentina
| | | | - Martín Montenegro
- Hospital Materno Infantil Ramón Sardá, City of Buenos Aires, Argentina
| | - Paula Juárez
- Hospital de la Madre y el Niño, La Rioja, Argentina
| | - Lucía Visani
- Hospital Cuenca Alta Néstor Kirchner, Cañuelas, Buenos Aires, Argentina
| | | | - Erika Barrozo
- Maternidad Provincial Teresita Baigorria, San Luis, Argentina
| | | | - Andrea V Das Neves
- Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina
| | - María F Valenti
- Argentine Society of Critical Care Medicine, City of Buenos Aires, Argentina
| | - María C Canseco
- Instituto de Maternidad y Ginecología nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán, Argentina
| | | | - Pedro Macharé
- Hospital Mi Pueblo, Florencio Varela, Buenos Aires, Argentina
| | - Ana K Marquez
- Hospital Municipal de Morón, Morón, Buenos Aires, Argentina
| | - Eva Rodriguez
- Hospital Simplemente Evita, González Catán, Buenos Aires, Argentina
| | | | - Laura Rapela
- Hospital Municipal del Carmen, Chacabuco, Buenos Aires, Argentina
| | | | - Rosshanna Nuñez
- Hospital Mariano y Luciano de la Vega, Moreno, Buenos Aires, Argentina
| | - Sebastián Torres
- Sanatorio Anchorena San Martín, San Martín, Buenos Aires, Argentina
| | - Miguel A González
- Hospital del Este "Eva Perón", San Miguel de Tucumán, Tucumán, Argentina
| | | | | | - Patricia Okurzaty
- Hospital Materno Infantil Ramón Sardá, City of Buenos Aires, Argentina
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Narang K, Weaver AL, Mehta RA, Garovic VD, Szymanski LM. Intraabdominal pressure as a marker for physiologic and pathologic processes in pregnancy. Hypertens Pregnancy 2022; 41:181-189. [DOI: 10.1080/10641955.2022.2085741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kavita Narang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Amy L. Weaver
- Division of Clinical Trial and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ramila A. Mehta
- Division of Clinical Trial and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, and Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Linda M. Szymanski
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Petrenko AP, Castelo-Branco C, Marshalov DV, Kuligin AV, Mysovskaya YS, Shifman EM, Abdulaev AMR. Physiology of intra-abdominal volume during pregnancy. J OBSTET GYNAECOL 2020; 41:1016-1022. [PMID: 33251897 DOI: 10.1080/01443615.2020.1820470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A total of 580 pregnant and 50 puerperal women were included in this cross-sectional study to assess the physiological changes that allow women to adapt to a chronic increase in intra-abdominal pressure during pregnancy. The volume of the uterus, intra-abdominal volume (IAV), visceral and subcutaneous fat was calculated. During pregnancy, the IAV increases up to 1.5 times. Changes in IAV until 24 weeks present a linear relationship (5.2%); thereafter, changes become exponential and, at 40 weeks, IAV increases by 61%. This fact is exclusively related to the progressive growth of the foetus and to the increase in uterine size. At term, the IAV reserve is exhausted, becoming equal the anteroposterior and transverse diameters of the abdomen.In conclusion, the adaptive capabilities of IAV related to the foetal growth are limited by the IAV reserve. The reserve capacity of the IAV and tensile properties of the abdominal wall can be estimated by the dynamics of the anteroposterior and transverse abdominal diameters.IMPACT STATEMENTWhat is already known on this subject? A causal relationship between intra-abdominal hypertension and the development of adverse obstetric and perinatal outcomes has been suggested. Nevertheless, the role of this condition as a leading cause of systemic dysfunction during pregnancy remains unrecognised and underestimated.What do the results of this study add? This study assesses the dynamics of IAV in uncomplicated singleton pregnancies.What are the implications of these findings for clinical practice and/or further research? The study of abdominal pressure indicators such as intra-abdominal volume and compliance will help to a better understand the aetiology, pathophysiology, prognosis and treatment strategies for pregnant women with intra-abdominal hypertension.
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Affiliation(s)
- Aleksei Petrovich Petrenko
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation.,City Clinical Hospital No. 1 named after Y.Ya. Gordeev, Saratov, Russian Federation
| | - Camil Castelo-Branco
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dimitry Vasilevich Marshalov
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation.,City Clinical Hospital No. 1 named after Y.Ya. Gordeev, Saratov, Russian Federation
| | - Alexander Valerievich Kuligin
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
| | | | - Efim Munevich Shifman
- Department of Anesthesiology and Critical Care, State Budgetary Healthcare Institution of Moscow Region, M. F. Vladimirskiy Moscow's Regional Research Clinical Institute, Moscow, Russian Federation
| | - Adam Muhamed Rasulovich Abdulaev
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation.,City Clinical Hospital No. 1 named after Y.Ya. Gordeev, Saratov, Russian Federation
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6
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Lozada MJ, Goyal V, Levin D, Walden RL, Osmundson SS, Pacheco LD, Malbrain MLNG. Management of peripartum intra-abdominal hypertension and abdominal compartment syndrome. Acta Obstet Gynecol Scand 2019; 98:1386-1397. [PMID: 31070780 PMCID: PMC7313226 DOI: 10.1111/aogs.13638] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 12/24/2022]
Abstract
Normal pregnancy leads to a state of chronically increased intra-abdominal pressure. Obstetric and non-obstetric conditions may increase intra-abdominal pressure further, causing intra-abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state-of-the-art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra-abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.
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Affiliation(s)
- M. James Lozada
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Varun Goyal
- Department of Anesthesiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Danielle Levin
- Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Sarah S. Osmundson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luis D. Pacheco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Manu L. N. G. Malbrain
- Intensive Care Unit, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Abstract
Damage-control surgery (abdominopelvic packing followed by a period of medical stabilization in the intensive care unit) is a life-saving intervention usually reserved for critically injured patients who may not survive an attempt to achieve hemostasis and complete repair of the damage in the operating room. Most obstetricians have little or no experience in this area, although the use of damage-control surgery in selected cases may be life-saving. This approach should be considered when arterial bleeding has been controlled and persistent bleeding is deemed to be secondary to coagulopathy that is refractory to blood product replacement, particularly in the presence of hypothermia, acidosis, and vasopressor requirement. A prototypical (albeit hypothetical) case is described here in which damage-control surgery is indicated.
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Lozada MJ, Goyal V, Osmundson SS, Pacheco LD, Malbrain MLNG. It's high time for intra-abdominal hypertension guidelines in pregnancy after more than 100 years of measuring pressures. Acta Obstet Gynecol Scand 2019; 98:1486-1488. [PMID: 31368113 DOI: 10.1111/aogs.13697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/24/2019] [Indexed: 01/31/2023]
Affiliation(s)
- M James Lozada
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Varun Goyal
- Department of Anesthesiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sarah S Osmundson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luis D Pacheco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Manu L N G Malbrain
- Intensive Care Unit, University Hospital Brussels (UZB), Jette, Belgium.,Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Garg D, Tyagi A. Intra-abdominal hypertension in pregnancy: Need for generating more evidence before providing sound clinical management recommendations. Acta Obstet Gynecol Scand 2019; 98:1485. [PMID: 31194878 DOI: 10.1111/aogs.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Devansh Garg
- Department of Anesthesia and Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Asha Tyagi
- Department of Anesthesia and Critical Care, University College of Medical Sciences & GTB Hospital, Delhi, India
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Tyagi A, Luthra A, Garg D. Critically Ill Obstetric Patients: Much more than Meets the Eye. Indian J Crit Care Med 2019; 23:493. [PMID: 31749564 PMCID: PMC6842841 DOI: 10.5005/jp-journals-10071-23274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
How to cite this article: Tyagi A, Luthra A, Garg D. Critically Ill Obstetric Patients: Much more than Meets the Eye. Indian J Crit Care Med 2019;23(10):493.
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Affiliation(s)
- Asha Tyagi
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Ankit Luthra
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Devansh Garg
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
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Tyagi A, Lahan S, Verma G, Das S, Kumar M. Role of Intra-abdominal Pressure in Early Acute Kidney Injury: A Prospective Cohort Study in Critically Ill Obstetric Patients. Indian J Crit Care Med 2018; 22:602-607. [PMID: 30186012 PMCID: PMC6108294 DOI: 10.4103/ijccm.ijccm_170_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims: This prospective cohort study evaluated intra-abdominal pressure (IAP) and its role in causing acute kidney injury (AKI) in critically ill obstetric patients and utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI. Methods: A total of 50 eligible obstetric patients admitted to our Intensive Care Unit were enrolled and daily IAP measured using indwelling Foley catheter. Early AKI was diagnosed as per the KDIGO criteria and urine assessed for NGAL using ELISA. Results: AKI was seen in 54% and intra-abdominal hypertension (IAH) in 21% patients. In patients with and without AKI, there was statistically similar IAP on day 1 (P = 0.542) and day 2 (P = 0.907) as well as incidence of IAH (19% vs. 23%) (P = 0.766). Area under receiver operating characteristic curve (AUC) for IAP to predict early AKI was 0.499 (95% confidence interval [CI]: 0.325–0.673) (P = 0.992). Urinary NGAL concentration was significantly greater in patients with early AKI compared to those without (P = 0.006); AUC for urinary NGAL to detect early AKI was 0.734 (95% CI: 0.583–0.884) (P = 0.006) and optimal cutoff was 53.7 ng/ml. Conclusions: IAH and AKI are common in critically ill obstetric patients. While IAP does not correlate with early AKI, NGAL is useful to predict AKI.
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Affiliation(s)
- Asha Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Shubham Lahan
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Gaurav Verma
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Shukla Das
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Mahendra Kumar
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
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