Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey

Wise, Robert; Roberts, Derek J.; Vandervelden, Stefanie; Debergh, Dieter; Waele, Jan J. De; Laet, I. De; Kirkpatrick, Andrew W.; Keulenaer, Bart L. De; Malbrain, Manu L N G

doi:10.5603/ait.2014.0051

Cited by 22 publications

(16 citation statements)

References 29 publications

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“…Intra-abdominal hypertension (IAH) is defined as a sustained increase in intra-abdominal pressure (IAP) equal to or above 12 mmHg [1]. Critical care physicians around the world still underestimate the high incidence of IAH which is around 25% in mixed ICU patients [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Regli

Pelosi

Malbrain

2019

Ann. Intensive Care

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The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world. One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay. IAH is associated with high morbidity and mortality. Although considerable progress has been made over the past decades, some important questions remain regarding the optimal ventilation management in patients with IAH. An important first step is to measure intra-abdominal pressure (IAP). If IAH (IAP > 12 mmHg) is present, medical therapies should be initiated to reduce IAP as small reductions in intra-abdominal volume can significantly reduce IAP and airway pressures. Protective lung ventilation with low tidal volumes in patients with respiratory failure and IAH is important. Abdominal-thoracic pressure transmission is around 50%. In patients with IAH, higher positive end-expiratory pressure (PEEP) levels are often required to avoid alveolar collapse but the optimal PEEP in these patients is still unknown. During recruitment manoeuvres, higher opening pressures may be required while closely monitoring oxygenation and the haemodynamic response. During lung-protective ventilation, whilst keeping driving pressures within safe limits, higher plateau pressures than normally considered might be acceptable. Monitoring of the respiratory function and adapting the ventilatory settings during anaesthesia and critical care are of great importance. This review will focus on how to deal with the respiratory derangements in critically ill patients with IAH.

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Section: Introductionmentioning

confidence: 99%

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Regli

Pelosi

Malbrain

2019

Ann. Intensive Care

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“…Intra-abdominal pressure is an important physiological parameter that is still often neglected by the medical community [4]. It should be measured regularly in critically ill patients, 4 to 6-hourly, according to the guidelines [1].…”

Section: Discussionmentioning

confidence: 99%

The role of point-of-care ultrasound in intra-abdominal hypertension management

Pereira

Pereira²,

Wise³

et al. 2017

Anaesthesiol Intensive Ther

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“…Although the first cases of ACS were described decades ago, interest has recently increased exponentially. Nevertheless, a recent survey demonstrated that knowledge among physicians is still suboptimal toward clinical management and awareness of ACS [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis

Damme¹,

Waele²

2018

Crit Care

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BackgroundDecompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney function and outcome.MethodsA systematic review and meta-analysis of the literature was performed. Articles reporting data on intra-abdominal pressure (IAP), hemodynamic (mean arterial pressures [MAP], central venous pressure [CVP], cardiac index [CI], heart rate [HR], systemic vascular resistance index [SVRI] and/or pulmonary capillary wedge pressure [PCWP]), respiratory (positive end-expiratory pressure [PEEP], peak inspiratory pressure [PIP] and/or ratio of partial pressure arterial oxygen and fraction of inspired oxygen [P/F ratio]), and/or urinary output (UO) following decompressive laparotomy were analyzed.ResultsA total of 15 articles were included; 3 included children only (aged 18 years or younger). Of the 286 patients who were included, 49.7% had primary ACS. The baseline mean IAP in adults decreased with an average of 18.2 ± 6.5 mmHg following decompression, from 31.7 ± 6.4 mmHg to 13.5 ± 3.0 mmHg. There was a decrease in HR (12.2 ± 9.5 beats/min; p = 0.04), CVP (4.6 ± 2.3 mmHg; p = 0.022), PCWP (5.8 ± 2.3 mmHg; p = 0.029), and PIP (10.1 ± 3.9 cmH2O; p < 0.001) and a mean increase in P/F ratio (70.4 ± 49.4; p < 0.001) and UO (95.3 ± 105.3 ml/h; p < 0.001). In children, there was a significant increase in MAP (20.0 ± 2.3 mmHg; p = 0.006), P/F ratio (238.2; p < 0.001), and UO (2.88 ± 0.64 ml/kg/h; p < 0.001) and a decrease in CVP (7 mmHg; p = 0.016) and PIP (9.9 cmH2O; p = 0.002). The overall mortality rate was 49.7% in adults and 60.8% in children following decompressive laparotomy.ConclusionsDecompressive laparotomy resulted in a significantly lower IAP and had beneficial effects on hemodynamic, respiratory, and renal parameters. Mortality after decompressive laparotomy remains high in both adults and children.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2103-0) contains supplementary material, which is available to authorized users.

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Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey

Abstract: This survey showed that although most responding clinicians claim to be familiar with IAH and ACS, knowledge of published consensus definitions, measurement techniques, and clinical management are inadequate.

Cited by 22 publications

References 29 publications

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

The role of point-of-care ultrasound in intra-abdominal hypertension management

Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis

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