Abstract
"Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous system function. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. A thorough understanding of the pathophysiologic implications of elevated intra-abdominal pressure is fundamental to 1) recognizing the presence of intra-abdominal hypertension and abdominal compartment syndrome, 2) effectively resuscitating patients afflicted by these potentially life-threatening diseases, and 3) preventing the development of intra-abdominal pressure-induced end-organ dysfunction and failure. The currently accepted consensus definitions surrounding the diagnosis and treatment of intra-abdominal hypertension and abdominal compartment syndrome are presented.
Highlights
Initially recognized over 150 years ago, the pathophysiologic implications of elevated intra-abdominal pressure (IAP) have essentially been rediscovered only within the past two decades [1,2,3]
Present, but significantly under-appreciated, intra-abdominal hypertension" (IAH) and abdominal compartment syndrome" (ACS) are recognized as common occurrences in the intensive care unit (ICU) setting [6,7,8,9,10,11,12,13,14,15,16]
IAP measurements to detect the presence of IAH, application of comprehensive medical management strategies to reduce elevated IAP and restore end-organ perfusion, timely surgical abdominal decompression for refractory organ dysfunction, and early attempts at fascial closure once physiologically appropriate [21,22]
Summary
Elevated IAP commonly causes marked deficits in both regional and global perfusion that, when unrecognized, result in significant organ failure and patient morbidity and mortality. Significant progress has been made over the past decade with regard to understanding the etiology of IAH and ACS as well as implementing appropriate resuscitative therapy. Routine measurement of IAP in patients at risk is essential to both recognizing the presence of IAH/ACS and guiding effective treatment. Adoption of the proposed consensus definitions and recommendations has been demonstrated to significantly improve patient survival from IAH/ACS and will facilitate future investigation in this area. IAP: intra-abdominal pressure; IAH: intra-abdominal hypertension; ACS: abdominal compartment syndrome; MAP: mean arterial pressure; APP: abdominal perfusion pressure; FG: filtration gradient; GFP: glomerular filtration pressure; PTP: proximal tubular pressure; PIP: peak inspiratory pressure; FiO2: fraction of inspired oxygen; PEEP: positive end-expiratory pressure; ICP: intracranial pressure; PAOP: pulmonary artery occlusion pressure; CVP: central venous pressure
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