Evaluation of the behavior of intra-abdominal pressure and incidence of intra-abdominal hypertension in patients undergoing liver transplantation

• Grant number: 16/18394-3
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• Start date: December 01, 2016
• End date: August 31, 2021
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Luiz Augusto Carneiro D'Albuquerque
• Grantee: Estrella Bianca de Mello
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Little information is available on the dynamics of Intra-abdominal Pressure (IAP) and its actual incidence after liver transplantation. The pathological increase in this pressure, also referred to as Intra-abdominal Hypertension (IAH), can lead to a derangement of tissue perfusion, thereby ultimately developing end-organ dysfunction, being characterized by the Abdominal Compartment Syndrome (ACS). Both clinical entities are associated with significant morbidity and mortality in postsurgical and critically ill patients. Therefore, the evaluation of IAP in the perioperative period of liver transplantation is of paramount importance. Objectives: The primary aim of this prospective study is to evaluate the IAP behavior in the perioperative period of patients undergoing liver transplantation since their admission just before surgery until the fifth postoperative day. Secondly, this study will also evaluate the incidence of IAH/ACS in these patients of the University of São Paulo hospital, at the Gastroenterology Intensive Care Unit (ICU). Methods: This study will enroll 100 consecutive patients undergoing liver transplantation. The IAP will be measured at the Operating Room (OR) after anesthesia induction, after closing the abdominal wall at the end of the surgery and every six hours until the fifth postoperative day. A closed system for intravesical intermittent measurement will be used in order to avoid infection. Blood and urine samples will be collected daily for laboratory analysis. Clinical variables will be also recorded. Exclusion criteria include patients submitted to peritoneostomy because of surgical complications, once the IAP equals the atmospheric pressure in these specific cases. Statistical Analysis: Data will be expressed as mean ± SD, median (interquartile range) or as percentage (number). Comparisons between the groups with and without IAH will be performed using Student T test, Wilcoxon test or chi-square test, according to the distribution. Temporal analysis of continuous variables will be performed using One-way or Two-way ANOVA for repeated measures when indicated. P values < 0.05 will be considered statistically significant. Statistical results will be performed using SPSS 20.0 (SPSS, Chicago, IL, USA). (AU)

Academic Publications

(References retrieved automatically from State of São Paulo Research Institutions)

MELLO, Estrella Bianca de. Evaluation of the behavior of intra-abdominal pressure and the incidence of intra-abdominal hypertension in patients undergoing liver transplantation. 2021. Doctoral Thesis - Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) São Paulo.