Evaluating Noninvasive, Apparatus-Based Monitoring of Organ Dysfunction in Critically Ill Children with Intra-abdominal hypertension and Abdominal Compartment Syndrome: A Prospective Cohort Study

Background: The interindividual variability of children's susceptibility to even slightly elevated IAP (intra-abdominal pressure) is unknown, as is the mechanism of transition from IAH (intra-abdominal hypertension = IAP > 10 mm Hg) to abdominal compartment syndrome (ACS = IAH⁺ organ dysfunction) and/or multiorgan dysfunction syndrome (MODS). Therefore, to improve the monitoring and assessability of micro- and macrocirculation in the context of IAP/IAH/ACS, we developed a multimodal monitoring concept and evaluated it as a prognostic tool.

Method: In addition to conventional PICU monitoring methods, IAP, hemodynamics (impedance cardiography), and tissue saturations and perfusion intensities of all accessible organs and tissues (NIRS/DTPM) were regularly quantified. ROC analyses were used to identify cut-off values for the development of less than two organ dysfunctions for each measurement procedure. For subsequent multivariable logistic regression modeling, selected factors were weighted in a univariate analysis (Wilcoxon's rank sum test). Results of the final model are given as odds ratios (OR, 95% CI), AUC, and a scoring method nomogram.

Results: In tertiary care PICU settings, finally, n = 231 children were included (median age = 0.9 years [range: 0 days–17.9 years], LOS-PICU = 7 [1–332] days, PRISM-III score 13.5 [0–40]). Median IAP was 7.4 [2–16] mm Hg, n = 66 (29%) children suffered from IAH, n = 31 from ACS (13%). Although 53% of the children treated had a cardiologic or cardiac surgery diagnosis, only 42% of all patients treated had cardiovascular dysfunction objectified by monitoring parameters. The likelihood of IAH was the same in cardiovascular compromised and noncompromised patients (28 vs. 29%). However, the occurrence of MODS and/or ACS was significantly more frequent in cardiovascular compromised patients (94 vs. 22% and 19 vs. 9%, respectively). Only the monitoring parameters, such as IAP level, somatic NIRS, and DTPM, of the liver with the cut-off limits of 10.8 mm Hg (AUC = 0.787, OR = 6.3), 82% (AUC = 0.659, OR = 0.67), and 0.111cm/s (AUC = 0.478, OR = 0.30), respectively, proved to be prognostically helpful with regard to the development of MODS (AUC of the joint model: 0.789).

Conclusion: According to the cohort observed here, IAP, somatic tissue saturation, and liver perfusion intensity appear to be prognostic indicators of the possible development of multiorgan dysfunction. In combination, they could represent a significant contribution to improving pediatric intensive care monitoring.

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Artikel online veröffentlicht:
12. Februar 2022