Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine

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ABSTRACTS OF ORAL PRESENTATIONS To cite this article: (2007) ABSTRACTS OF ORAL PRESENTATIONS, Acta Clinica Belgica, 62:sup1, 246-272, DOI: 10.1179/acb.2007.62.s1.033 To link to this article:

Published online: 30 May 2014.

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THE EFFECT OF BODY POSITION ON INTRA-ABDOMINAL PRESSURE MEASUREMENT: A MULTICENTER ANALYSIS Cheatham M.L., De Waele J., De Keulenaer B., Widder S., Kirkpatrick A., Cresswell B., Malbrain M., Bodnar Z., Meija J., Reis R., Parr M., Schulze R., Compano S. and the WSACS Clinical Trials Group

LONG-TERM IMPACT OF THE OPEN ABDOMEN: A PROSPECTIVE COMPARATIVE ANALYSIS Cheatham M.L., Safcsak K. Dept. of Surgical Education, Orlando Regional Medical Center, Orlando, Florida, USA

Introduction: Intra-abdominal pressure (IAP) has traditionally been measured with the patient supine, however, head of bed elevation is advocated to reduce ventilator-associated pneumonia. Aim: To determine the impact on IAP of three different body positions (supine, 15, and 30 degree elevation of the head). Patients and Methods: A prospective, multicentre trial was approved by the Institutional Review Board / Ethics Committee at each study site. Inclusion criteria included age ≥ 18 years, sedated and on mechanical ventilation, and demonstrating at least one risk factor for intra-abdominal hypertension or abdominal compartment syndrome (ACS). Patients were excluded if unable to tolerate changes in body position. Three sets of IAP measurements at each body position were performed at least 4 hours apart. IAP was measured using the transvesical technique (AbViser, Wolfe-Tory Medical, Salt Lake City, UT) with an instillation volume of 20 mL. The zero reference point was the mid-axillary line at the iliac crest. Data are reported as either mean ± SD or mean with 95% CI. Bias is reported with 95% CI. Results: 132 patients were enrolled from 12 sites (392 total IAP measurements). 43% of patients were medical, 39% surgical, and 18% trauma. APACHE-II was 21±11, SAPS-2 was 44±18, and SOFA was 10±7. No patient developed aspiration as a result of being placed supine during the study.

Introduction: The open abdomen (OA) is a frequent consequence of abdominal compartment syndrome (ACS). We have previously shown in a retrospective study that the resulting hernias decrease physical, but not mental health perception compared to the general population. Aim: To prospectively determine whether long-term physical and mental health perception differs between patients with an OA vs. patients in whom primary fascial closure is possible. Patients and Methods: Over a 36-month period, 278 consecutive patients requiring an OA for ACS were prospectively followed. 215 patients were excluded due to death, fascial closure within 48 hours, or inability to obtain consent. The remaining patients were categorized upon discharge as either OPEN (massive incisional hernia) or CLOSED (primary fascial closure). After obtaining informed consent, the SF-36v2™ Health Survey (Quality Metric, Inc.) was sent to patients at 6 month intervals post-hospital discharge. OPEN and CLOSED patients were compared to each other as well as to the US general population. Data are presented as mean (95% confidence interval). The normalized Physical Component Health Summary (PCS) score is 50.0 (45.2-54.8) and the Mental Component Health Summary (MCS) score is 50.0 (43.5-56.5). Results: 30 of 37 OPEN and 14 of 26 CLOSED patients gave informed consent. 70% returned at least one survey. Patient age, APACHE-II, SAPS-2, and ISS did not differ between groups. PCS and MCS scores at 6 and 18 months are listed below. Time to return to work was 5.7 (3.7-9.5) vs. 5.9 (4.0-7.8) months. 68% of OPEN and 91% of CLOSED patients have no employment limiting disability due to their OA (p=0.22; Fisher’s Exact).

n All patients


IAP < 20 mmHg


IAP ≥ 20 mmHg


Mean Range Bias Mean Range Bias Mean Range Bias


15 degrees

30 degrees

11.8 (11.4-12.2) 7-29 --11.3 (10.9-11.6) 2-19 --22.5 (21.6-23.4) 20-29 ---

13.3 (12.8-13.8) 5-26 1.5 (1.2-1.7) 12.9 (12.5-13.3) 4-25 1.6 (1.4-1.8) 22.3 (21.3-23.3) 17-28 0.2 (-0.8-1.2)

15.4 (14.9-15.9) 7-28 3.7 (3.4-4.0) 15.0 (14.6-15.5) 2-30 3.8 (3.5-4.1) 25.2 (23.7-26.8) 16-36 2.7 (1.2-4.2)

Conclusion: Head of bed elevation results in significant increases in measured IAP. Such changes are most pronounced at 30 degrees and for IAP 12 mmHg) with the FoleyManometer (Holtech, Kopenhagen, Denmark). The IAP was recorded four times daily together with the highest and lowest APP, fluid balance, and SOFA score. Until now data are collected on 258 patients (mainly medical, n=211) and the study will be continued until 350 patients. The major endpoint is ICU mortality. Values are mean±SD. Unpaired student’s t test was used for statistical analyses. Results: Reason for mechanical ventilation was: Acute on chronic respiratory failure: 13% (COPD 73.3%), Acute respiratory failure: 59% (Postoperative 30.7% CAP 11.4%, Sepsis 11.4%, CPR 10.2%, Aspiration 8%) and Coma: 28% (Hemorrhagic stroke 28%, Metabolic 20%, Overdose 16%, TBI 8%, Ischemic stroke 8%). The BMI was 25.5±6.3, M/F ratio 1/1, age 64.1±16.7, APACHE-II 22±9.7, SAPS-II 51.4±18. SOFA score on day1 was 9.8±3.7 with 2.1±1 organ failures. IAP on day1 was 10.3±6.2 mmHg, while APP was 52.9±15.1. On admission, IAH was present in 32.5% and ACS in 2.9%. Mortality was 48.8%. On univariate analysis (Table 1) age, severity scores, capillary leak index and fluid balance were predictive for outcome while IAP and APP were not. Outcome didn’t differ between patients with or without IAH on admission. Non-survivors had a significantly (p

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