Measuring intra-abdominal pressure in the intensive care setting

Abstract

Increased intra-abdominal pressure (IAP) may occur in critically ill patients. The easiest method to estimate IAP at the bedside is the bladder pressure measurement. A standard procedure (same volume infused, pressure transducers, and patient‘s position) should be used to obtain comparable and reproducible data among different patients and during different stages and time of the disease. The increase in IAP leads to two major pathological conditions: 1) the intraabdominal hypertension (IAP above 16 cmH2O) and 2) the abdominal compartment syndrome (IAP above 30 cmH2O). Increased IAP negatively affects pulmonary, cardiovascular, renal, gastrointestinal and central nervous system function. Most of critically ill patients have an intraabdominal hypertension, while few of them (less than 5%) present clinical characteristics of abdominal compartment syndrome. IAP is different among different categories of patients. The highest mean values during intensive care unit stay have been reported in respiratory and cardiologic patients among medical categories and in neurologic patients among surgical patients. IAP seems to be correlated with severity scores but its relation to mortality is uncertain. Routine measurements of IAP by means of bladder pressure are not associated with an increased rate of urinary tract infections. Future trials are warranted to better evaluate the role of routine IAP measurements on clinical management of critically ill patients.