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How does Intra-abdominal Pressure Affect the Daily Management of My Patients?

  • I. E. De Laet
  • J. J. De Waele
  • M. L. N. G. Malbrain

Abstract

A compartment syndrome exists when increased pressure in a closed anatomic space threatens the viability of the enclosed tissue. When this occurs in the abdominal cavity the impact on end-organ function within and outside the cavity can be devastating. The abdominal compartment syndrome (ACS) is not a disease; as such it can have many causes and it can develop within many disease processes. Unlike many commonly encountered disease processes which remain within the purview of a given discipline, intra-abdominal hypertension (IAH) and the ACS readily cross the usual barriers and may occur in any patient population regardless of age, illness, or injury. In an attempt to bring together all physicians and other health care workers who are confronted on a regular basis with the adverse effects of IAH, the World Society of the Abdominal Compartment Syndrome (WSACS, www.wsacs.org) was founded.

Keywords

Mean Arterial Blood Pressure Abdominal Compartment Syndrome Pulse Pressure Variation Stroke Volume Variation Intraabdominal Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Malbrain ML, Cheatham ML, Kirkpatrick A, et al (2006) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 32: 1722–1732CrossRefPubMedGoogle Scholar
  2. 2.
    Malbrain ML (2004) Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 30: 357–371CrossRefPubMedGoogle Scholar
  3. 3.
    Kirkpatrick AW, Brenneman FD, McLean RF, Rapanos T, Boulanger BR (2000) Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg 43: 207–211PubMedGoogle Scholar
  4. 4.
    Sugrue M, Bauman A, Jones F, et al (2002) Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 26: 1428–1431CrossRefPubMedGoogle Scholar
  5. 5.
    Kron IL, Harman PK, Nolan SP (1984) The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 199: 28–30PubMedCrossRefGoogle Scholar
  6. 6.
    Cheatham ML, Safcsak K (1998) Intraabdominal pressure: a revised method for measurement. J Am Coll Surg 186: 594–595CrossRefPubMedGoogle Scholar
  7. 7.
    Harrahill M (1998) Intra-abdominal pressure monitoring. J Emerg Nurs 24: 465–466CrossRefPubMedGoogle Scholar
  8. 8.
    Balogh Z, De Waele JJ, Malbrain ML (2007) Continuous intra-abdominal pressure monitoring. Acta Clin Belg Suppl 62: 26–32Google Scholar
  9. 9.
    Balogh Z, Jones F, D’Amours S, Parr M, Sugrue M (2004) Continuous intra-abdominal pressure measurement technique. Am J Surg 188: 679–684CrossRefPubMedGoogle Scholar
  10. 10.
    Collee GG, Lomax DM, Ferguson C, Hanson GC (1993) Bedside measurement of intraabdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. Intensive Care Med 19: 478–480CrossRefPubMedGoogle Scholar
  11. 11.
    Malbrain ML, De Laet I, Viaene D, Schoonheydt K, Dits H (2008) In vitro validation of a novel method for continuous intra-abdominal pressure monitoring. Intensive Care Med 34: 740–745CrossRefPubMedGoogle Scholar
  12. 12.
    Malbrain ML, Chiumello D, Pelosi P, et al (2005) Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: A multiple-center epidemiological study. Crit Care Med 33: 315–322CrossRefPubMedGoogle Scholar
  13. 13.
    Malbrain ML, Deeren D, De Potter TJ (2005) Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 11: 156–171CrossRefPubMedGoogle Scholar
  14. 14.
    Cheatham M, Malbrain M (2006) Cardiovascular implications of elevated intra-abdominal pressure._In: Ivatury R, Cheatham M, Malbrain M, Sugrue M (eds) Abdominal compartment syndrome. Landes Bioscience, Georgetown, pp 89–104.Google Scholar
  15. 15.
    Kashtan J, Green JF, Parsons EQ, Holcroft JW (1981) Hemodynamic effect of increased abdominal pressure. J Surg Res 30: 249–255CrossRefPubMedGoogle Scholar
  16. 16.
    Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ (1995) Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma 39: 1071–1075CrossRefPubMedGoogle Scholar
  17. 17.
    Richardson JD, Trinkle JK (1976) Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res 20: 401–404CrossRefPubMedGoogle Scholar
  18. 18.
    Malbrain ML, Cheatham ML (2004) Cardiovascular effects and optimal preload markers in intra-abdominal hypertension. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer-Verlag, Heidelberg, pp 519–543Google Scholar
  19. 19.
    Cheatham M, Malbrain M (2006) Abdominal perfusion pressure. In: Ivatury R, Cheatham M, Malbrain M, Sugrue M (eds) Abdominal Compartment Syndrome. Landes Bioscience, Georgetown 69–81Google Scholar
  20. 20.
    Simon RJ, Friedlander MH, Ivatury RR, DiRaimo R, Machiedo GW (1997) Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma 42: 398–403CrossRefPubMedGoogle Scholar
  21. 21.
    Burchard KW, Ciombor DM, McLeod MK, Slothman GJ, Gann DS (1985) Positive end expiratory pressure with increased intra-abdominal pressure. Surg Gynecol Obstet 161: 313–318PubMedGoogle Scholar
  22. 22.
    Pelosi P, Ravagnan I, Giurati G, et al (1999) Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 91: 1221–1231CrossRefPubMedGoogle Scholar
  23. 23.
    Sugrue M, D’Amours S (2001) The problems with positive end expiratory pressure (PEEP) in association with abdominal compartment syndrome (ACS). J Trauma 51: 419–420CrossRefPubMedGoogle Scholar
  24. 24.
    Sussman AM, Boyd CR, Williams JS, DiBenedetto RJ (1991) Effect of positive end-expiratory pressure on intra-abdominal pressure. South Med J 84: 697–700PubMedGoogle Scholar
  25. 25.
    Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1997) A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 25: 496–503CrossRefPubMedGoogle Scholar
  26. 26.
    Kallet RH, Katz JA, Pittet JF, et al (2000) Measuring intra-esophageal pressure to assess transmural pulmonary arterial occlusion pressure in patients with acute lung injury: a case series and review. Respir Care 45: 1072–1084PubMedGoogle Scholar
  27. 27.
    Dellinger RP, Carlet JM, Masur H, et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30: 536–555CrossRefPubMedGoogle Scholar
  28. 28.
    Rivers E, Nguyen B, Havstad S, et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345: 1368–1377CrossRefPubMedGoogle Scholar
  29. 29.
    Cheatham ML, Block EF, Nelson LD, Safcsak K (1998) Superior predictor of the hemodynamic response to fluid challenge in critically ill patients. Chest 114: 1226–1227CrossRefPubMedGoogle Scholar
  30. 30.
    Cheatham ML, Nelson LD, Chang MC, Safcsak K (1998) Right ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure. Crit Care Med 26: 1801–1806CrossRefPubMedGoogle Scholar
  31. 31.
    Schachtrupp A, Graf J, Tons C, Hoer J, Fackeldey V, Schumpelick V (2003) Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension. J Trauma 55: 734–740CrossRefPubMedGoogle Scholar
  32. 32.
    Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL (2003) Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 124: 1900–1908CrossRefPubMedGoogle Scholar
  33. 33.
    Cheatham ML, Safcsak K, Block EF, Nelson LD (1999) Preload assessment in patients with an open abdomen. J Trauma 46: 16–22CrossRefPubMedGoogle Scholar
  34. 34.
    Chang MC, Miller PR, D’Agostino R Jr, Meredith JW (1998) Effects of abdominal decompression on cardiopulmonary function and visceral perfusion in patients with intra-abdominal hypertension. J Trauma 44: 440–445CrossRefPubMedGoogle Scholar
  35. 35.
    Brienza N, Dambrosio M, Cinnella G, Conte M, Puntillo N, Bruno F (1996) [Effects of PEEP on intrathoracic and extrathoracic blood volumes evaluated with the COLD system in patients with acute respiratory failure. Preliminary study]. Minerva Anestesiol 62: 235–242PubMedGoogle Scholar
  36. 36.
    Malbrain M, Debaveye Y, Bertieaux S (2000) Effect of abdominal compression and decompression on cardiorespiratory function and regional perfusion. Intensive Care Med 26:S264 (abst)Google Scholar
  37. 37.
    Malbrain ML, De Laet I (2008) Functional haemodynamics during intra-abdominal hypertension: what to use and what not. Acta Anaesthesiol Scand 52: 576–577CrossRefPubMedGoogle Scholar
  38. 38.
    Duperret S, Lhuillier F, Piriou V, et al (2007) Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med 33: 163–171CrossRefPubMedGoogle Scholar
  39. 39.
    Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF (2000) Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 49: 621–626CrossRefPubMedGoogle Scholar
  40. 40.
    Malbrain ML (2002) Abdominal perfusion pressure as a prognostic marker in intra-abdominal hypertension._In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer-Verlag, Heidelberg, pp 792–814Google Scholar
  41. 41.
    Ranieri VM, Brienza N, Santostasi S, et al (1997) Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome: role of abdominal distension. Am J Respir Crit Care Med 156: 1082–1091PubMedGoogle Scholar
  42. 42.
    Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158: 3–11PubMedGoogle Scholar
  43. 43.
    Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK (1991) Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol 70: 2611–2618PubMedGoogle Scholar
  44. 44.
    Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK (1992) Volume infusion produces abdominal distension, lung compression, and chest wall stiffening in pigs. J Appl Physiol 72: 575–582CrossRefPubMedGoogle Scholar
  45. 45.
    De laet I, Malbrain ML (2007) ICU management of the patient with intra-abdominal hypertension: what to do, when and to whom? Acta Clin Belg Suppl 62: 190–199Google Scholar
  46. 46.
    Quintel M, Pelosi P, Caironi P, et al (2004) An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury. Am J Respir Crit Care Med 169: 534–541CrossRefPubMedGoogle Scholar
  47. 47.
    Slutsky AS, Ranieri VM (2000) Mechanical ventilation: lessons from the ARDSNet trial. Respir Res 1: 73–77CrossRefPubMedGoogle Scholar
  48. 48.
    Biancofiore G, Bindi L, Romanelli AM, et al (2002) Renal failure and abdominal hypertension after liver transplantation: determination of critical intra-abdominal pressure. Liver Transpl 8: 1175–1181CrossRefPubMedGoogle Scholar
  49. 49.
    Biancofiore G, Bindi ML, Romanelli AM, et al (2003) Postoperative intra-abdominal pressure and renal function after liver transplantation. Arch Surg 138: 703–706CrossRefPubMedGoogle Scholar
  50. 50.
    Sugrue M, Buist MD, Hourihan F, Deane S, Bauman A, Hillman K (1995) Prospective study of intra-abdominal hypertension and renal function after laparotomy. Br J Surg 82: 235–238CrossRefPubMedGoogle Scholar
  51. 51.
    Sugrue M, Hallal A, D’Amours S (2006) Intra-abdominal pressure hypertension and the kidney. In: Ivatury R, Cheatham M, Malbrain M, Sugrue M (eds) Abdominal Compartment Syndrome. Landes Bioscience, Georgetown, pp 119–128Google Scholar
  52. 52.
    Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K (1999) Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 134: 1082–1085CrossRefPubMedGoogle Scholar
  53. 53.
    De laet I, Malbrain ML, Jadoul JL, Rogiers P, Sugrue M (2007) Renal implications of increased intra-abdominal pressure: are the kidneys the canary for abdominal hypertension? Acta Clin Belg Suppl 62: 119–130Google Scholar
  54. 54.
    Kula R, Szturz P, Sklienka P, Neiser J, Jahoda J (2004) A role for negative fluid balance in septic patients with abdominal compartment syndrome? Intensive Care Med 30: 2138–2139CrossRefPubMedGoogle Scholar
  55. 55.
    De laet I, Citerio G, Malbrain ML (2007) The influence of intraabdominal hypertension on the central nervous system: current insights and clinical recommendations, is it all in the head? Acta Clin Belg Suppl 62: 89–97Google Scholar
  56. 56.
    Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36: 815–818CrossRefPubMedGoogle Scholar
  57. 57.
    Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1996) Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma 40: 936–941CrossRefPubMedGoogle Scholar
  58. 58.
    Citerio G, Vascotto E, Villa F, Celotti S, Pesenti A (2001) Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 29: 1466–1471CrossRefPubMedGoogle Scholar
  59. 59.
    Deeren D, Dits H, Malbrain MLNG (2005) Correlation between intra-abdominal and intracranial pressure in nontraumatic brain injury. Intensive Care Med 31: 1577–1581CrossRefPubMedGoogle Scholar
  60. 60.
    Malbrain ML, De laet I (2008) AIDS is coming to your ICU: be prepared for acute bowel injury and acute intestinal distress syndrome. Intensive Care Med 34: 1565–1569CrossRefPubMedGoogle Scholar
  61. 61.
    Daugherty EL, Hongyan L, Taichman D, Hansen-Flaschen J, Fuchs BD (2007) Abdominal compartment syndrome is common in medical intensive care unit patients receiving largevolume resuscitation. J Intensive Care Med 22: 294–299CrossRefPubMedGoogle Scholar
  62. 62.
    Oda J, Ueyama M, Yamashita K, et al (2006) Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. J Trauma 60: 64–71CrossRefPubMedGoogle Scholar
  63. 63.
    O’Mara MS, Slater H, Goldfarb IW, Caushaj PF (2005) A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma 58: 1011–1018CrossRefPubMedGoogle Scholar
  64. 64.
    Ziakas PD, Voulgarelis M, Felekouras E, Anagnostou D, Tzelepis GE (2005) Myelofibrosisassociated massive splenomegaly: a cause of increased intra-abdominal pressure, pulmonary hypertension, and positional dyspnea. Am J Hematol 80: 128–132CrossRefPubMedGoogle Scholar
  65. 65.
    Hamad GG, Peitzman AB (2006) Morbid obesity and chronic intra-abdominal hypertension. In: Ivatury R, Cheatham M, Malbrain M, Sugrue M (eds) Abdominal Compartment Syndrome. Landes Bioscience, Georgetown, pp 187–194Google Scholar
  66. 66.
    Sugerman HJ (2001) Effects of increased intra-abdominal pressure in severe obesity. Surg Clin North Am 81: 1063–1075CrossRefPubMedGoogle Scholar
  67. 67.
    Sugerman HJ (1998) Increased intra-abdominal pressure in obesity. Int J Obes Relat Metab Disord 22:1138CrossRefPubMedGoogle Scholar
  68. 68.
    Sugerman HJ, DeMaria EJ, Felton WL III, Nakatsuka M, Sismanis A (1997) Increased intraabdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 49: 507–511PubMedGoogle Scholar
  69. 69.
    Kimball EJ, Kinikini DV, Mone MC, et al (2006) Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm. Crit Care Med 33 (suppl 12):A38 (abst)Google Scholar
  70. 70.
    Kimball EJ (2006) Intra-abdominal hypertension and the abdominal compartment syndrome: ‘ARDS’ of the gut. Int J Intensive Care Spring:1–7Google Scholar
  71. 71.
    Kirkpatrick AW, Balogh Z, Ball CG, et al (2006) The secondary abdominal compartment syndrome: iatrogenic or unavoidable? J Am Coll Surg 202: 668–679CrossRefPubMedGoogle Scholar
  72. 72.
    Reintam A, Parm P, Kitus R, Starkopf J, Kern H (2008) Gastrointestinal Failure Score in critically ill patients: a prospective observational study. Crit Care 12:R90CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • I. E. De Laet
    • 1
  • J. J. De Waele
    • 2
  • M. L. N. G. Malbrain
    • 1
  1. 1.Department of Intensive CareZNA StuivenbergAntwerpBelgium
  2. 2.Surgical Intensive Care UnitGhent University HospitalGhentBelgium

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