Effect of Intra-Abdominal Hypertension & Abdominal Compartment Syndrome Guidelines on Critical Care Nurses’ Performance and on Patients’ Outcomes

Abstract

Background: Literature review had cited that, Intra-Abdominal Pressure (IAP) monitoring helps in the early detection of patients who are susceptible for developing Intra-Abdominal Hypertension (IAH) and enabling prompt treatment to prevent the development of Abdominal Compartment Syndrome (ACS). Purpose: is to evaluate the effect of intra-abdominal hypertension & abdominal compartment syndrome guidelines on critical care nurses’ performance, and on selected patients’ outcomes among critically ill patients. Methods: a quasi- experimental study was conducted in intensive critical care medicine unit affiliated to Cairo university hospitals and Manial university specialized hospital (third unit), involving 100 male & female adult patients with IAH risk factors (50 matched subjects in each study and control groups).47 male and female critical care nurses were recruited within quasi-experimental (pre and post test one group) research design. Four tools were used to collect data pertinent to this study. Both patients groups (study and control) received the routine hospital care in addition to intervention guidelines for the study group. Follow-up assessments evaluated patient outcomes including length of ICU stay, duration of mechanical ventilation connection, frequency of abdominal compartment syndrome, mortality rate and organ failure . The study hypothesized that the implementation of the guidelines would result in improving outcomes for the study group patients as compared to the control group ones and critical care nurses performance. Results: The majority of both patients groups were females, their age was more than 60 years old. The most prominent comorbidities in both groups were Hypertension and Diabetes Mellitus and 80% of the both groups were none smoker. The majority of nurses group were females, their age were between 20-30 years old and most of them were technical nursing secondary school. The 1^st hypothesis can be supported as a statistical difference was put into evidence between the pre and post intervention critical care nurses groups as regards IAH& ACS knowledge (t= 32.411, P value= 0.00). As well, the 2^nd hypothesis can also be supported as a significant statistical difference was found between the pre and the post intervention critical care nurses groups regarding intra-abdominal pressure measuring (F: 388.538, P value: 0.00). However, the 3^rd hypothesis regarding length of ICU stay and mechanical ventilator day connection can’t be supported, as there were no significant differences between patients group with the following χ² and p values (χ² =6.009, p = 0.422) and (χ² = 9.458, p = 0.124) respectively. Moreover, the frequency of abdominal compartment syndrome, mortality rate was lower in the study group with the following χ² and p values (χ2= 4.00, P value= 0.04), (χ² = 4.596, p = 0.03) respectively. which also can support the 4^th and 5^th hypotheses. Similarly, the 6^th hypothesis related to organ failure can be supported as the study group showed lower mean of SOFA score than control group with the following t and p values (χ2= 11.34, P value= 0.01).Conclusion: Outcomes of IAH&ACS patients can be improved when applying IAH risk factors assessment algorithm and a designed nursing intervention protocol through reducing frequency of ACS, mortality rate and a mean SOFA score. Moreover, it increases nurses’ knowledge and skills regarding intra-abdominal pressure measurement and nursing intervention for patients with IAH&ACS. Recommendation: Monitoring of IAP& early detection of IAH among critically ill patients need to be highly considered within the routine management protocol frameworks for IAH risk patients.