Intraabdominal hypertension is less common than it used to be: A pilot step wedge trial.

Objective: This is a pilot study to determine the feasibility of a multicentre stepped wedge cluster randomized trial of implementing the 2013 World Society of the Intraabdominal Compartment Syndrome (WSACS) guidelines as an intervention to treat intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in critically ill patients. Design: Single-centre before-and-after trial, with an observation / baseline period of 3 months followed by a 9-month intervention period. Setting: A 35 bed medical-surgical-trauma intensive care unit in a tertiary level, Canadian hospital. Patients: Recruitment from consecutively admitted adult intensive care unit patients. Intervention: In the intervention period, treatment teams were prompted to implement WSACS interventions in all patients diagnosed with IAH. Measurements and Main Results: 129 patients were recruited, 59 during the observation period and 70 during the intervention period. Only 17.0% and 12.9%, respectively, met diagnostic criteria for IAH. Many recruited patients did not have intraabdominal pressures measured regularly per study protocol. There was no difference in ICU mortality for patients in either cohort or between those with and without IAH. Conclusions: The incidence of IAH in our patient population has decreased significantly since 2015. This is likely due to a significant change in routine care of critically ill patients, especially with respect to judicious goal-directed fluid resuscitation. Patient recruitment and protocol adherence in this study were low, exacerbated by other staffing and logistical pressures during the study period. We conclude that a larger multicentre trial is unlikely to yield evidence of a detectable treatment effect.