Biomarkers for intra-abdominal pressure: another tool in the toolbox?

Abstract

This editorial refers to ‘Utility of plasma CA125 as a proxy of intra-abdominal pressure in patients with acute heart failure’ by J. Rubio-Gracia et al., https://doi.org/10.1093/ehjacc/zuac046. Intra-abdominal pressure (IAP) is more than just a vital sign. High IAP, or intra-abdominal hypertension (IAH) (defined by a sustained or repeated elevation in IAP ≥ 12 mmHg), measured at end-expiration, in a supine patient and in the presence of abdominal musculature at rest is strongly associated with both organ system failure and mortality in the critically ill patient1 (Figure 1). Measurement of IAP also allows an accurate assessment of abdominal perfusion pressure (APP) calculated as the difference between mean arterial pressure (MAP) and IAP.2 This, like mean perfusion pressure (MPP), calculated as MAP minus central venous pressure (CVP) may be a specific marker for resistive abdominal forces and is closely associated with acute kidney injury (AKI).3,4 While mild-to-moderate IAH per se may be medically managed, including improvement of abdominal compliance, aggressive deresuscitation (in case of fluid accumulation),5 or increasing perfusion pressure (systolic arterial pressure or MAP), a sustained increase of IAP >20 mmHg in the presence of new organ system injury, despite medical treatment defines abdominal compartment syndrome (ACS) and necessitates emergent surgical decompression.6