actores de riesgo para hipertensión intra abdominal en pacientes ventilados mecánicamente

Factores de riesgo para hipertensión intra abdominal en pacientes ventilados mecánicamente Risk factors for intra-abdominal hypertension in mechanically ventilated patients. BLASER, A. R., PAR, P., KITUS, R. and STARKOPF, J. Acta Anaesthesiologica Scandinavica 2011; 55: 607-614.                       doi: 10.1111/j.1399-6576.2011.02415.x Background: Intra-abdominal hypertension (IAH) in intensive care patients is associated with an adverse outcome, but the risk factors for development of IAH have not been extensively studied. We aimed to identify independent risk factors for IAH in mechanically ventilated (MV) patients. Methods: In this prospective observational study, 563 MV patients staying in the general intensive care unit (ICU) of a university hospital for more than 24 h were observed during their ICU stay. Repeated intermittent measurements of intra-abdominal pressure (IAP) via the urinary bladder were performed. Results: IAH (sustained or repeated IAP≥12 mmHg) developed in 182 patients (32.3%). From all the study patients, 44.4% had a primary pathology in the abdomino-pelvic region. Two thirds of all IAH cases developed in this group. Obesity [body mass index (BMI)>30], high positive end-expiratory pressure (PEEP>10), respiratory failure (PaO2/FiO2 <300), use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding and laparotomy on admission day were identified as independent risk factors for IAH. None of the patients without any of these risk factors (26 patients) developed IAH. Conclusion: The precise prediction of development IAH in mixed ICU population remains difficult. In the absence of BMI>30, PEEP>10 cmH2O, PaO2/FiO2 <300, use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding and laparotomy on admission day, the risk for development of IAH in MV ICU patients is minimal. http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2011.02415.x/pdf   Efecto de la presión intra abdominal sobre la función hepática valorada con LiMON en pacientes graves. Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients. Inal MT, Memis D, Sezer YA, Atalay M, Karakoc A, Sut N. The Department of Anesthesiology, Trakya University Medical Faculty, Edirne, Turkey. Can J Surg. 2011 Apr 1;54(2):42709. doi: 10.1503/cjs.042709. Abstract Background: Intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with significant morbidity and mortality in critically ill patients. Our aim was to assess the effects of IAH on liver function using the noninvasive liver function monitoring system LiMON and to assess the prognostic value of IAP in critically ill patients. Methods: We conducted a retrospective analysis of critically ill patients who were treated in the intensive care unit (ICU). The IAP and indocyanine green plasma disappearance rate (ICG-PDR) measurements were made within 24 hours after admission to the ICU and repeated 12 hours later. Intra-abdominal pressure was measured via a Foley bladder catheter, and ICG elimination tests were conducted concurrently using the LiMON. Results: We included 30 critically ill patients (17 women and 13 men aged 28-89 yr) in our analysis. Statistical analysis showed that the baseline IAP values were significantly higher among nonsurvivors than survivors (19.38 [standard deviation; SD 2.08] v. 13.07 [SD 0.99]). The twelfth-hour IAP values were higher than baseline measurements among nonsurvivors (21.50 [SD 1.96]) and lower than baseline measurements among survivors (11.71 [SD 1.54]); the difference between groups was significant (p < 0.001). The baseline ICG-PDR values were significantly lower among nonsurvivors than survivors (10.86 [SD 3.35] v. 24.51 [SD 6.78]), and the twelfth-hour ICGPDR values were decreased in all groups; the difference between groups was significant (p < 0.001). Conclusion: Our results suggest that measurement of ICG-PDR with the LiMON is a good predictor of the effects of IAP on liver function and, thus, can be recommended for the evaluation of critically ill patients http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjs/vol-54/issue-2/pdf/pg42709.pdf

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