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Postoperative Intra-abdominal Hypertension Predicts Worse In-hospital Outcome In Children After Cardiac Surgery
yunyi zhang, Shouping Wang, Yue Wang, Yibing Fang, shuhua luo.
West China Hospital Sichuan University, Chengdu, China.

Objectives: To determine the incidence, predictors, and outcome of intra-abdominal hypertension(IAH) in children after cardiac surgery.Methods: The prospective observational single-center study includes 154 consecutive patients. Intra-abdominal pressure(IAP) was measured preoperatively after intubation as a baseline, and postoperatively every 6 hours using a Foley bladder catheter. IAH was defined as a sustained increase in IAP higher than 10 mmHg. The logistic regression was used for predictors analyses.Results: The median age and body weight were 25.0(8.4-69.9) months and 11.0(7-19.5) kg respectively. A total of 1745 measurements were performed. The IAP at admission to ICU[7(5-8)mmHg] was significantly higher than the baseline[3(2-4)mmHg] (p=0.00). One-fourth of patients(24.6%) developed IAH postoperatively with six abdominal compartment syndrome. Around four-fifths of IAH occurred within 24hours after ICU admission. The multivariable analysis showed certain anatomy(single-ventricle and right-heart surgery, OR:3.30, p=0.001), baseline IAP(OR:2.84, p=0.005), and CPB duration(OR: 2.89, p=0.004) were the independent predictors for IAH occurrence. IAH was associated with grater (p=0.001) inotropic support, more gastrointestinal complications(p=0.00), sepsis(p=0.00), longer ventilation(p=0.042), as well as ICU(p=0.001) duration. The occurrence of composite outcomes including death, arrest, renal/hepatic failure, lactic acidosis, or extracorporeal-membrane-oxygenation was significantly more in patients with IAH (p=0.001).ConclusionIAH was common in children undergoing cardiac surgery and associated with worse in-hospital outcomes. Our data suggested that several factors may be related to the development of IAH including baseline cardiac physiology, preoperative abdominal characteristics, and surgical-associated inflammation.


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