A Clinician's Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Intra-abdominal hypertension: definitions, monitoring, interpretation and management.

This review will describe the definitions on intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In order to understand these definitions the reader must be aware of the interactions between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV), explaining why dramatic IAP increases can be observed in some patients related to anthropomorphic measurements, body positioning, use of positive pressure ventilation, or relatively small accumulations of fluid or blood. The adverse effects related to increased IAP have been named IAH for moderate cases and ACS for advanced cases. In order to improve clinical communication as well as evaluation of the scientific literature, the World Society for the Abdominal Compartment Syndrome (WSACS) has published its first guidelines and definitions in 2006. The definitions and guidelines have recently been revised according to evidence based medicine and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This review will be based on the revised guidelines. The standard method to measure IAP is via the bladder and as experience with IAP measurement has evolved considerably, a number of tips and potential pitfalls are listed.

IAH/ACS: the rationale for surveillance.

Surveillance for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) should be implemented in every intensive care unit (ICU), because it has been demonstrated that surveillance is effective. Several criteria that have led to the conclusion that IAH/ACS monitoring is of value: First, IAH is a frequent problem in critically ill patients that directly affects function of all organ systems to some degree, and that is associated with considerable mortality. Furthermore, simple tools for intra-abdominal pressure (IAP) monitoring are available, and it can be safely applied without the need for advanced tools. Finally, both ACS and IAH can be treated with either medical or surgical interventions. Treatment for IAH/ACS should be selected on the basis of the severity of symptoms and the cause of IAH. IAP monitoring should also be incorporated in the daily ICU management of the patient.

Intra-abdominal hypertension: evolving concepts.

This article focuses primarily on the recent literature on abdominal compartment syndrome (ACS) and the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome. The definitions regarding increased intra-abdominal pressure (IAP) are listed and are followed by an overview of the different mechanisms of organ dysfunction associated with intra-abdominal hypertension (IAH). Measurement techniques for IAP are discussed, as are recommendations for organ function support and options for treatment in patients who have IAH. ACS was first described in surgical patients who had abdominal trauma, bleeding, or infection; but recently, ACS has been described in patients who have other pathologies. This article intends to provide critical care physicians with a clear insight into the current state of knowledge regarding IAH and ACS.

Current insights in intra-abdominal hypertension and abdominal compartment syndrome: open the abdomen and keep it open!

BACKGROUND AND AIMS: The abdominal compartment syndrome (ACS) is associated with organ dysfunction and mortality in critically ill patients. Furthermore, the deleterious effects of increased IAP have been shown to occur at levels of intra-abdominal pressure (IAP) previously deemed to be safe. The aim of this article is to provide an overview of all aspects of this underrecognized pathological syndrome for surgeons. METHODS AND CONTENTS: This review article will focus primarily on the recent literature on ACS as well as the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome. The definitions regarding increased IAP will be listed, followed by a brief but comprehensive overview of the different mechanisms of organ dysfunction associated with intra-abdominal hypertension (IAH). Measurement techniques for IAP will be discussed, as well as recommendations for organ function support in patients with IAH. Finally, surgical treatment and management of the open abdomen are briefly discussed, as well as some minimally invasive techniques to decrease IAP. CONCLUSIONS: The ACS was first described in surgical patients with abdominal trauma, bleeding, or infection, but in recent years ACS has also been described in patients with other pathologies such as burn injury and sepsis. Some of these so-called nonsurgical patients will require surgery to treat their ACS. This review article is intended to provide surgeons with a clear insight into the current state of knowledge regarding IAH, ACS, and the impact of IAP on the critically ill patient.