Intra-abdominal hypertension among critically ill patients in an intensive care unit in Ghana

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Background Early detection and management of intra-abdominal hypertension (IAH) improve clinical outcomes in critically ill patients in the intensive care unit (ICU). Data on IAH among ICU patients are sparse in Ghana and the sub-region. This study evaluated the prevalence and clinical outcomes of IAH in Ghana. Materials and methods We conducted a prospective observational study of a mixed ICU population from 1 May to 30 November 2023 at a major referral hospital in Ghana. Patients 16 years or older had their intra-abdominal pressure (IAP) measured at admission and every 6 h for 48 h using the modified Kron's technique, and IAP was defined and graded according to standard criteria. Descriptive statistics were used to summarise patient characteristics and estimate prevalence, and logistic regression was performed to identify predictors of IAH. Results In total, 89 patients, with a median age of 43 (interquartile range 29–58), were studied. A heterogeneous group of 58 (77.6%) patients were admitted for postoperative critical care or circulatory failure. Nearly all (88 patients, 98.9%) had identifiable risk factors. In total, 31 (39.7%), 22 (28.2%), and 25 (32.1%) patients had 1, 2, and 3 or more concurrent risk factors, respectively. In the ICU, 42 patients (47.2%) developed IAH, with Grade I IAH being the most prevalent ( n = 27, 64.3%). The majority of the patients ( n = 39, 92.9%) developed IAH within 24 h of admission. Having a higher number of predefined IAH risk factors was independently associated with the development of IAH after adjustment for age (OR 11.37, 95% CI 3.84–33.66, p < 0.001). Patients who developed IAH had significantly higher Sequential Organ Failure Assessment scores (e.g., Day 1: 8.42 vs. 6.25, p < 0.01, Day 7: 6.09 vs. 3.27, p < 0.02) throughout the first 7 days of ICU admission and fewer ventilator-free days (13.5 vs. 21.3 days, p < 0.001). The mortality rate was significantly higher in the patients diagnosed with IAH (>40% vs. 20.9%, p < 0.01). Conclusion IAH was common among critically ill patients and occurred predominantly within the first 24 h of ICU admission. Patients with multiple recognised risk factors were at an increased risk of developing IAH. The findings support targeted IAP surveillance among high-risk ICU patients in resource-limited settings.

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