Intra-abdominal hypertension, fluid balance, and adverse outcomes after orthotopic liver transplantation

Intra-abdominal hypertension (IAH) is frequently encountered in critically ill surgical patients. We aimed to evaluate the incidence of IAH after orthotopic liver transplant (OLT) and its impact on organ function, hospital length-of-stay (LOS), and death. This prospective, observational, cohort stud...

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Published inJournal of critical care Vol. 62; pp. 271 - 275
Main Authors Freitas, Marlon S, Nacul, Flavio E., Malbrain, Manu L.N.G., Silva, Rita C.M.A., Lobo, Francisco R.M., Oliveira, Neymar E., da Silva, Renato F, Lobo, Suzana M.
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.04.2021
Elsevier Limited
Subjects
Abdomen
Creatinine
Critical care
Hypertension
Liver diseases
Liver transplants
Mortality
Patients
Regression analysis
Sepsis
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Summary:Intra-abdominal hypertension (IAH) is frequently encountered in critically ill surgical patients. We aimed to evaluate the incidence of IAH after orthotopic liver transplant (OLT) and its impact on organ function, hospital length-of-stay (LOS), and death. This prospective, observational, cohort study evaluated consecutive adult patients admitted in the ICU after undergoing OLT. Intra-abdominal pressure (IAP) was measured every 4–6 h for 3 days. Worsening IAP was defined as a gradual increase in IAP over a period of time. Daily fluid balance was the daily sum of all intakes minus the output. IAH was observed in 48% of the patients within the first 3 days after ICU admission, while ACS was diagnosed in 15%. Patients with IAH had a higher positive fluid balance at day 1 (1764 mL [812–2733 mL] vs. 1301 mL [241–1904 mL], p = 0.025). Worsening IAH was associated with fewer days free of organ dysfunction. IAH within 72 h after ICU admission was independently associated with a composite outcome of death or a longer ICU LOS (odds ratio 2.9; CI 95% 1.02–8.25, p = 0.043). After OLT, nearly half of the patients presented IAH, that was associated with unfavorable outcomes. •IAH after orthotopic liver transplant was frequent and associated with death or a longer ICU lenght of stay•A more positive fluid balacnce was associated with intra-abdominal hipertension•Worsening IAH was associated with fewer days free of organ dysfuncion
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ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2020.12.021