Utility of monitoring intra-abdominal pressure in critically ill children

Objective: To assess the usefulness of intra-abdominal pressure (IAP) measurement, by the intra-vesical method, in order to identify those patients at risk of developing intra-abdominal hypertension, as well as to analyse the factors that affect the IAP, and to determine their influence on the prognosis in critically ill patients. Patients and methods: Prospective observational study in critically ill children in whom the IAP was monitored as soon as signs of intra-abdominal hypertension appeared. The following variables were analysed: age, sex, reason for admission, underlying disease, previous surgeries, blood pressure, heart rate, central venous pressure, urine output, inotropic therapy, sedation, muscle relaxation, mechanical ventilation, renal replacement techniques, extracorporeal membrane oxygenation, and mortality. Results: A total of 39 patients were studied. At 24 hours from initiating the monitoring of IAP, 74.4% showed IAP >= 12 mmHg, 33.3% > 15 mmHg, and 15.4% > 20 mmHg. After 48 hours, 59% had intra-abdominal hypertension. There was a correlation between the central venous pressure (CVP) and IAP at 24 and 48 hours (r = 0.500, P=.001 and r = 0.360, P=.040, respectively). There was no correlation with the other parameters. Only 9 patients required urgent decompression and none developed abdominal compartment syndrome. Conclusions: IAP monitoring can be useful to diagnose and to promptly treat intra-abdominal hypertension, and thus to prevent the abdominal compartment syndrome. Therefore, it should be measured in critically ill children with abdominal pathology. (c) 2011 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L. All rights reserved.