Incidence, Outcomes, and Factors Associated with Intra-Abdominal Hypertension and Primary Abdominal Compartment Syndrome in Abdominopelvic Injury Patients.

Abstract

Background: The primary aim was to identify the incidence of intra-abdominal hypertension (IAH) and primary abdominal compartment syndrome (1^oACS) of abdominopelvic injury patients at Thammasat University Hospital (TUH), Thailand, and the secondary objective was to evaluate those factors that contributed to developing these conditions.

Methods: The retrospective cohort of 38 abdominopelvic injury cases was admitted to the intensive care unit at Thammasat University Hospital, from January 1^st to December 31^st, 2018. The bladder pressure was recorded every 4 hours until the urethral catheter was removed. Data of age, gender, weight, height, body mass index, injury mechanisms, initial vital signs, imaging, laboratory data, blood component requirements, abdominal organs involved, treatments including surgery and intervention radiology, abbreviated injury scale (AIS) and injury severity score (ISS), length of ICU stays, and results of treatment were all analyzed.

Results: The patients were mostly young (mean age 31.5 years), male (68.4%), and suffering from blunt trauma (89.5%). The mean maximum bladder pressure was 8.3 ± 5.2 mmHg. Six patients (15.8%) developed IAH, and one patient (2.6%) was diagnosed with 1^oACS. Two patients expired. The multivariate analysis showed the patient who had initial Cr ≥ 1.5 g/dL, lower extremity including pelvis AIS ≥3, and ISS >15 was significantly associated with the developing of IAH.

Conclusions: The incidence of IAH and 1^oACS was 15.8% and 2.6%. Predicted factors to find developing IAH were initial Cr ≥ 1.5 g/dL, lower extremity AIS ≥3, and ISS >15. We should consider awareness of IAH and 1^oACS in abdominopelvic injury patients.