Ashish Khanna, MD, FCCP, FASA,FCCM
Anesthesiologist & Intensivist, Associate Professor of Anesthesiology
Wake Forest Baptist Medical Center
Winston Salem, North Carolina
Disclosure information not submitted.
Steven Minear, MD
Assistent Professor
Cleveland Clinic Florida, United States
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Amit Prabhakar, MD, MS
Assistant Professor of Anesthesiology
Emory University School of Medicine, United States
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Kelly Stanton, PhD
Senior Analyst
Potrero Medical, United States
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Leina Essakalli, MS, BA
Junior data scientist
Potrero Medical, United States
Disclosure information not submitted.
Bev Ann Blackwell, BA
Principal clinical research associate and data manager
Potrero Medical, United States
Disclosure information not submitted.
Nia Sweatt, BS
researcher
Wake Forest University Health Sciences, United States
Disclosure information not submitted.
Kelsey Flores, BA
researcher
Wake Forest University Health Sciences, United States
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Lynnette Harris, BSN, RN, CCRC
Research Nurse Manager
Wake Forest Baptist Medical Center, United States
Disclosure information not submitted.
Amit Saha, MS, PhD
Assistant Professor, Anesthesiology
Wake Forest Baptist Health, United States
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Camila Teixeira, MD
Fellow
Cleveland Clinic Florida, United States
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Katherine Egan, BSN, RN, CCRC
Manager Clinical Research
Emory University School of Medicine, United States
Disclosure information not submitted.
Vanessa Moll, MD, PhD, FCCM, FASA, DESA
Adjunct Associate Professor
Emory University School of Medicine
Atlanta, United States
Disclosure information not submitted.
Title: Intra-Abdominal Hypertension Detected by Continuous Monitoring Is Common and Persistent in the CVICU
Introduction: The incidence of intra-abdominal hypertension (IAH) in critically ill patients ranges from 15 to 35%. Cardiac surgery (CS) patients are at risk for IAH due to associated hypothermia and fluid shifts. IAH compromises abdominal perfusion pressure and can lead to abdominal compartment syndrome (ACS), increasing morbidity and mortality. Traditional IAP measurement is intermittent and reserved for patients with suspicion for ACS. This multicenter observational study used a novel, continuous IAP monitoring system to describe IAH in CS patients.
Methods: We studied 173 CS patients from 3 centers as part of an ongoing registry to evaluate IAH incidence and related outcomes. All patients received the Accuryn monitoring system (Potrero Medical, Hayward, CA) which continuously tracks UOP, IAP, and temperature. IAP was recorded (starting after anesthetic induction) at 100Hz, downsampled to 1Hz. 1Hz IAP signals were grouped into 30s windows with 1s overlap. The minimum value in this 30s group was captured as a running minimum. This correlates with end-expiration and true IAP. Signal noise from patient coughing/positioning was minimized by applying a 10min running median. Data were then resampled every 15 minutes. Statistics were calculated using python with pandas and numpy packages. IAH was graded according to the World Society of Abdominal Compartment Syndrome.
Results: We analyzed 138 CS patients with 397,440 IAP measurements for a 24h period. Baseline IAP was 5.64mmHg (CI:0.01-12.13) and foley dwell-time was 67.98h (CI:25.36-193.18). Mean duration of surgery was 5.4h (CI: 3.0-9.4); mean bypass time was 1.9h (CI: 0.7-3.6). 100% of patients had IAH during the first 24h postop, with an average of 5.3h (CI: 0.0-20.2) spent above 20mmHg. Two patients spent at least 12h in grade (G) 1, 42 in G 2, 10 in G 3, and 2 in G 4 IAH. During the entire foley dwell time, 19 patients spent ≥12h in G 1, 56 in G 2, 52 in G 3, and 15 in G 4 IAH, respectively.
Conclusions: >Continuous high-fidelity monitoring of IAP shows high, persistent levels of IAP in CS patients. A large percentage of this cohort was shown to be in advanced grade IAH, which may have been missed by targeted bladder pressure sampling. Future investigation is planned to develop predictive models for the early detection of IAH, ACS, and AKI in these patients.