Intra-Abdominal Pressure Monitoring after Ruptured Abdominal Aortic Aneurysm Surgery

(Department of Cardiovascular Surgery, Saisei-kai Yokohamashi Nanbu Hospital, Yokohama, Japan, Cardiovascular Division*1, Emergency Center*2, Yokohama City University School of Medicine, Medical Center, Yokohama, Japan and First Department of Surgery, Yokohama City University School of Medicine*3 Yokohama, Japan)

Susumu Isoda Masato Okita Akira Sakamoto
Tamitaro Soma Kiyotaka Imoto*1 Shin-ichi Suzuki*1
Keiji Uchida*1 Nobuyuki Kosuge*2 Yoshinori Takanashi*3
In the postoperative treatment of ruptured abdominal aortic aneurysm surgery, the relationship between intra-abdominal pressure (IAP) and the clinical course is not been clearly understood. From April 2000 to January 2003, we treated 109 cases of abdominal aortic aneurysm surgery (non-rupture 71 cases, rupture 38 cases) and measured intra-abdominal pressure in 30 of the ruptured cases which we analyzed in this study. The patients were divided into 2 groups. The H-group included 12 patients with maximum IAP equal to or higher than 20mmHg, and the L-group included 18 patients with a maximum IAP less than 20mmHg. Clinical characteristics were compared between the 2 groups. The mean age was 79.3}7.6yr in the H-group and 70.7}10.1yr in the L-group (p0.019). Preoperative shock was diagnosed in 83.3% of the H-group patients, and 61.1% of the L-group patients the (p0.26). Postoperative maximum values of intra-abdominal pressure were 22.3}2.0mmHg in the H-group, and 15.4}2.4mmHg in the L-group. Duration of intubation was 87.7}110.0h in the H-group, and 25.1}29.2h in the L-group (p0.04). Food intake was started 14.4}11.2d after surgery in the H-group, and 8.5}4.8d after surgery in the L-group (p0.094). The length of ICU stay was 6.7}6.5d in the H-group, and 2.9}2.1d in the L-group (p0.033). Length of hospital stay after surgery was 54.1}25.8d in the H-group, and 25.2}6.8d in the L-group (p0.001). Complications occurred in 8 cases out of 11 surviving cases (73%) in the H-group, and in 3 cases out of 17 surviving cases (18%) in the L-group (p0.0024). Complication in the H-group included acute renal failure, paralytic ileus, respiratory failure, abdominal wall dehiscence, and acute arterial occlusion, and that in the L-group included acute renal failure, upper limb paresis, and lower limb paresis. Monitoring of intra-abdominal pressure was considered beneficial to recognize complication and decide therapeutic strategy after ruptured aortic aneurysm surgery.
@Jpn. J. Cardiovasc. Surg. 33: 314-318 (2004)