Hemodynamics assessment in critically ill children with increased intra-abdominal pressure
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Background
Intra-abdominal pressure (IAP) is the pressure concealed within the abdomen. IAP is a sustained increase in IAP ≥ 12 mmHg. A consensus definition from 2013 states that IAH in children is a sustained or repeated elevation in IAP greater than 10 mmHg.
Aim of the study
Evaluate the prevalence of increased intra-abdominal pressure and its impact on morbidity in the pediatric intensive care unit. To assess hemodynamics in these critically ill children using vasoactive drugs.
Patients and methods
This prospective study was carried out on 50 pediatric patients from 4 to 156 months (27 males and 23 females) admitted to the PICU, Tanta University Hospital. Intra-abdominal pressure of all patients was measured by the bladder method at admission and 4 h after performing IAP-decreasing techniques.
Results
Before interventions, there was a statistically significant increase in IAP in groups II, III, and IV compared to group I. After interventions, there was a statistically significant increase in groups III and IV compared with group I. Regarding abdominal perfusion pressure (APP), there was a statistically significant increase within each group after interventions. IAP was a significant predictor of hemodynamic instability, with a cut-off value of greater than 12 mmHg.
Conclusion
Elevated IAP in critically ill pediatric patients was associated with high prevalence and significant hemodynamic disturbances, including compromised cardiac output (CO), increased systemic vascular resistance (SVRI), and reduced APP. The targeted pharmacologic therapy, involving the administration of suitable vasoactive medications (Epinephrine, Dobutamine, Norepinephrine, and Milrinone), effectively reduced IAP, leading to notable improvements in these hemodynamic parameters.
