The relationship of abdominal perfusion pressure with mortality in critically ill pediatric patients.
J Pediatr Surg
; 54(9): 1731-1735, 2019 Sep.
Article
en En
| MEDLINE
| ID: mdl-30638664
ABSTRACT
PURPOSE:
To the best of our knowledge, in the literature, there is no data regarding clinical utility of the abdominal perfusion pressure (APP) in critically ill children. Thus, in the present study, we aimed to investigate the clinical utility of APP in predicting of survival in critically ill children with IAH.DESIGN:
A prospective cohort study of patients between 1â¯month to 18â¯years who had risk for intra-abdominal hypertension from June 2013 to January 2014.SETTING:
Pediatric intensive care unit (PICU) at a tertiary university hospital. PATIENTS Thirty-five (16 female) PICU patients who had risk for the development of IAH were included. Serial intraabdominal pressure (IAP) and mean arterial pressure (MAP) measurements were performed. Abdominal perfusion pressure was calculated using the formula (MAP-IAP). MEASUREMENTS AND MAINRESULTS:
Overall mortality rate was 49% (nâ¯=â¯17). The mortality rate in patients with IAP mean ≥10â¯mmHg (nâ¯=â¯27, 77%) was 55% (nâ¯=â¯15), while 53% (nâ¯=â¯16) in patients with IAP max ≥10â¯mmHg (nâ¯=â¯30, 86%) and 47% (nâ¯=â¯7) in patients with IAP minâ¯≥â¯10â¯mmHg (nâ¯=â¯15, 43%). Overall mean APP was 58⯱â¯20â¯mmHg. Logistic regression analysis revealed that decrease in minAPP was associated with increased risk for mortality (Odds ratio for each 1â¯mmHg decrease in APP was 1.052 [CI 95%, 1.006-1.100], pâ¯<â¯0.05). ROC curve analysis revealed that, in predicting mortality, area under curve for minAPP was 0.765. The optimal cut-off point for APP was obtained as 53â¯mmHg with the 77.8% sensitivity and 70.6% specificity using the IU method.CONCLUSIONS:
Our findings showed that APP seems to be a useful tool in predicting mortality. Interventions to improve APP may be associated with better outcomes in critically ill PICU patients. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Diagnostic.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Perfusión
/
Enfermedad Crítica
/
Hipertensión Intraabdominal
Tipo de estudio:
Observational_studies
/
Prognostic_studies
Límite:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Idioma:
En
Revista:
J Pediatr Surg
Año:
2019
Tipo del documento:
Article