Mild to moderate intra-abdominal hypertension: Does it matter?

Abstract

This review summarizes the epidemiology, pathophysiological consequences and impact on outcome of mild to moderate (Grade I to II) intra-abdominal hypertension (IAH), points out possible pitfalls in available treatment recommendations and focuses on tasks for future research in the field. IAH occurs in about 40% of ICU patients. Whereas the prevalence of abdominal compartment syndrome seems to be decreasing, the prevalence of IAH does not. More than half of IAH patients present with IAH grade I and approximately a quarter with IAH grade II. However, most of the studies have addressed IAH as a yes-or-no variable, with little or no attention to different severity grades. Even mild IAH can have a negative impact on tissue perfusion and microcirculation and be associated with an increased length of stay and duration of mechanical ventilation. However, the impact of IAH and its different grades on mortality is controversial. The influence of intra-abdominal pressure (IAP) on outcome most likely depends on patient and disease characteristics and the concomitant macro- and microcirculation. Therefore, management might differ significantly. Today, clear triggers for interventions in different patient groups with mild to moderate IAH are not defined. Further studies are needed to clarify the clinical importance of mild to moderate IAH identifying clear triggers for interventions to lower the IAP.

MICU1 may be a promising intervention target for gut-derived sepsis induced by intra-abdominal hypertension

“…9 Our findings have been supported by the work of Maddison et al . 24 We found that as the IAP increases to 20 mm Hg for 90 min, intestinal barriers become seriously disrupted and dysbiosis occurs. 25 However, in the present study, at the same level of IAH, MICU1 exhibited a compensatory response towards the increased intestinal permeability, indicating that under IAH, the gut promotes a self-protective mechanism.…”

Reduction of Intra-abdominal Hypertension Is Associated with Increase of Cardiac Output in Critically Ill Patients Undergoing Mechanical Ventilation

“…3 IAH frequently appears in patients who develop an inflammatory process inside the abdominal cavity and can be further exacerbated by the excessive fluid therapy in these cases. 6 An increase of IAP has been proved to be associated with a significant reduction of the splanchnic blood flow. 16,17 Intraoperative and postoperative optimization of fluid administration has been proved to be strongly associated with a reduction in mortality in critically ill patients; however, in a study by Liu et al, static preload variables represented by central venous pressure and pulmonary capillary wedge pressure were not able to predict the cardiac response to fluid therapy in patients with IAH.…”

“…5 Abdominal compartment syndrome represents the final stage of a severe condition characterized by an increase in IAP to a degree that compromises the regional blood flow in vital abdominal organs. 6 Abdominal compartment syndrome is considered nowadays a life-threatening condition, being associated with significant deterioration in cardiac, renal, and respiratory function. 4 Therefore, in mechanically ventilated patients, all the necessary therapeutic measures should be undertaken in order to prevent the progression of IAH to more severe stages and abdominal compartment syndrome.…”

Predictive Factors for Intraabdominal Hypertension after Incisional Hernia Repair

“…Patients at risk of developing IAH/ACS can be divided into two categories: patients who suffer an increase of the intraabdominal content volume and patients with decreased abdominal volume (management of abdominal wall defects). Both groups can be characterized by an increase of the IAP values, but patients in the first category are prone to further decompensation subsequently to ischemia-reperfusion injuries in the mesenteric area accompanied by the need for hydric resuscitation [IAH occurs in about 40% of the intensive care unit patients (3)]. This type of evolution can only further increase the degree of edema and consequently leads to the intolerance of IAP rise.…”