Table 1:
Best evidence papers
| Author, date, journal and country Study type (level of evidence) | Patient group | Outcomes | Key results | Comments |
|---|---|---|---|---|
| Kilic et al. (2020), Turk gogus kalp damar cerrahisi dergisi, Turkey [2] Observational study (level IV) |
July 2016–January 2017 100 cardiac surgery patients on CPB 49 IAH (≥12 mmHg) 51 non-IAH Length of ITU stay, fluid balance, CVP and RIFLE score WSACS Intravesicular IAP method at induction, 0, 12 and 24 h |
Central venous pressure | IAP r = 0.499; P = 0.0001 | Significant increase at 12 and 24 h found only in IAH group Patients developing IAH were also found to have higher rates of AF (P = 0.002) and aortic atheroma (0.003) |
| Hypertension | OR 6.87; P = 0.023 | |||
| Age | OR 0.93; P = 0.032 | |||
| Intraoperative lactate | OR 0.57; P = 0.035 | |||
| CPB time | 93 ± 47 vs. 60 ± 25 min; P = 0.0001 | |||
| Inotrope usage | P < 0.002 | |||
| Transfusion requirements | 2.3 ± 1 vs 0.5 ± 0.7 units; P = 0.0001 | |||
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| Nazer et al. (2019), Surgery, Saudi Arabia [3] Observational study (level IV) |
January–August 2018 50 CABG patients 25 obese (≥30 kg/m2) 25 non-obese (<30 kg/m2) Haemodynamic parameters, liver function and Schindl score WSACS Intravesicular IAP method 4 hourly for 24 h |
IAH incidence | 84 vs 20%; P < 0.001 | 1:1 matching of groups based on BMI (≥30 kg/m2) No difference in transfusion requirement, postoperative dialysis or mortality |
| Baseline IAP | 10.3 ± 2.4 vs 8.4 ± 2.4 mmHg; P = 0.001 | |||
| Change in IAP | 5.1 ± 3.3 vs 2.2 ± 2.4 mmHg; P = 0.001 | |||
| Peak IAP | 15.4 ± 1.6 vs 10.6 ± 1.6 mmHg; P = 0.011 | |||
| Mean APP | 63.0 ± 8.0 vs 70.1 ± 11 mmHg; P = 0.017 | |||
| Renal injury | 32% vs 8%; P = 0.034 | |||
| Peak ALT | 59.0 ± 15 vs 46.5 ± 9 U/l; P = 0.045 | |||
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| Mazeffi et al. (2016), J Cardiothorac Vasc Anesth, USA [4] Observational study (level IV) |
Duration not specified 42 cardiac surgery patients on CPB 35 IAH (≥12 mmHg) 7 non-IAH Pre- and postoperative renal function WSACS intravesicular IAP method at 0, 3, 6, 12 and 24 h |
Postoperative fluid balance | 1,731 vs 1,812 ml; P = 0.88 | Small number of patients (n = 7) without IAH No significant association with CPB time, or ventricular function with IAH Peak IAP after 3–6 h postoperatively |
| Total perioperative fluid balance | 4,841 vs 3,118 ml; P = 0.79 | |||
| Renal injury | RR −31.4, 95% CI −48.0 to 6.3; P = 0.09 | |||
| Urinary NGAL at 24 h | 156.0 ± 228.2 vs 25.3 ± 25.5 ng/ml; P = 0.002 | |||
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| Smit et al. (2016), Ann Intensive Care, The Netherlands [5] Observational study (level IV) |
October 2014–March 2015 186 elective patients 38 obese (≥30 kg/m2) 148 non-obese (<30 kg/m2) Pre- and postoperative renal function WSACS intravesicular IAP method at ICU admission |
Mean IAP (mmHg) | 10.4 ± 4.7 vs 8.7 ± 4.2 mmHg; P = 0.031 | IAP >20 mmHg measured in 4 patients IAH has 26.9% prevalence BMI and WHR responsible for 5% of IAP variance in IAP No significant correlation between IAP and perfusion or cross-clamp time |
| IAH | 39.5% vs 23.6%; P = 0.667 | |||
| Postoperative creatinine | IAP r2 = 0.003; P = 0.491 | |||
| WC | IAP 9.2 ± 4.3 vs 8.9 ± 4.4 mmHg; P = 0.687 | |||
| WHR | IAP 9.3 ± 4.3 vs 8.9 ± 4.4 mmHg; P = 0.171 | |||
| CPB time | 177.6 ± 95.4 vs 143.7 ± 64.5 min; P = 0.049 | |||
| BMI | IAP r2 = 0.05; P = 0.003 | |||
| Iyer et al. (2014), Crit Care Resusc, Australia [6] Observational study (level IV) |
February–May 2013 108 adult patients; elective and emergency 50 IAH (≥12 mmHg) 58 non-IAH Haemodynamics, SOFA, APACHE II scores, liver and renal function WSACS intravesicular IAP method twice daily |
SOFA score | >6, AUC 0.65; P = 0.01 | No reported incidence of ACS Data analysed only for 5 postoperative days (>90% of study cohort) Peak in IAP at postoperative day 5 |
| CPB time | 120 vs 93 min; P = 0.01 | |||
| Cross-clamp time | 80 vs 70 min; P = 0.02 | |||
| ITU stay | 3 vs 2 days; P = 0.005 | |||
| CVP (mmHg) | 18 ± 4.0 vs 15 ± 3.1 mmHg; P < 0.001 | |||
| Serum AST | ≥46 U/l AUC 0.65; P = 0.04 | |||
| Serum albumin | ≤32 g/l AUC 0.63; P = 0.04 | |||
| Admission pH | 7.27 ± 0.06 vs 7.30 ± 0.05; P = 0.01 | |||
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| Dalfino et al. (2013), Interact CardioVasc Thorac Surg, Italy [7] Observational study (level IV) |
3 months (date not specified) 69 on- and off-pump elective patients 22 IAH (≥12 mmHg) 47 non-IAH Haemodynamic data, fluid balance, urine output, SOFA and RIFLE scores WSACS intravesicular IAP method at induction, 2, 4 6, 12 and 24 h |
Fluid balance | IAP r2 = 0.4548, P < 0.0001 | No association between IAH and hypertension, peripheral arterial disease or CPB time |
| CVP (mmHg) | IAP (r = 0.3881, P < 0.0001) IAH OR 3.35, 95% CI 1.68 to 5.37; P = 0.012 |
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| Baseline IAP | OR 4.58, 95% CI 2.76 to 5.72; P = 0.002 | |||
| Vasopressor usage | OR 4.81, 95% CI 1.57 to 6.9; P = 0.029 | |||
| SOFA score | OR 2.68, 95% CI 1.85 to 3.93; P = 0.049 | |||
| On-pump surgery | OR 2.73, 95% CI 1.92 to 5.12; P = 0.037 | |||
| Acute kidney injury | OR 2.27, 95% CI 1.12 to 4.71; P = 0.035 | |||
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| Dabrowski and Rzecki (2009), Acta Clin Belg, Poland [8] Observational study (level IV) |
January 2006–December 2007 50 adult cardiac surgery patients 27 group A (<75 kg) 23 group B (>75 kg) WSACS intravesicular IAP method at 11 perioperative time points |
BMI | Baseline IAP r = 0.8; P < 0.0001 Postoperative IAP r = 0.79; P < 0.001 |
Peak IAP noted to occur 6 h after surgery, with decreasing trend after 18 h Drop in APP associated with drop in MAP, no association with body weight Significant correlations between IAP and cardiac output, MAP, stroke volume and pulmonary wedge pressure |
| CVP | IAP r = 0.55; P < 0.001 | |||
| CPB time | IAP group A r = 0.34; P < 0.05 | |||
| Actual body weight | IAH prevalence χ2 = 1.08; P = 0.28 | |||
| APP | MAP r = 0.96; P ≤ 0.001 SVR r = 0.38; P < 0.001 |
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ACS: abdominal compartment syndrome; APP: abdominal perfusion pressure; AST: aspartate aminotransferase; BMI: body mass index; CABG: coronary artery bypass graft; CPB: cardiopulmonary bypass; CVP: central venous pressure; IAH: intra-abdominal hypertension; IAP: intra-abdominal pressure; MAP: mean arterial pressure; NGAL: neutrophil gelatinase-associated lipocalin; SOFA: Sequential Organ Failure Assessment score; SVR: systemic vascular resistance; WSACS: World Society of the Abdominal Compartment Syndrome; OR: odds ratio; RIFLE: risk, injury failure, loss of kidney function and end-stage renal disease; ALT: alanine aminotransferase; RR: risk ratio; CI: condifence interval; WHR: waist to hip ratio; WC: waist circumferencel; ITU: intensive therapy unit.