This article is part of the supplement: Diagnosis and management of intra-abdominal hypertension and abdominal compartment syndrome
Should we measure intra-abdominal pressures in every intensive care patient?
1 Department of Anaesthesiology and Intensive Care, University of Tartu, 8 L. Puusepa Str, 51014, Tartu, Estonia
2 Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, 8 L. Puusepa Str, 51014, Tartu, Estonia
3 Department of Intensive Care Medicine, University Hospital (Inselspital) and University of Bern, 3010 Bern, Switzerland
Annals of Intensive Care 2012, 2(Suppl 1):S9 doi:10.1186/2110-5820-2-S1-S9Published: 5 July 2012
Intra-abdominal pressure (IAP) is seldom measured by default in intensive care patients. This review summarises the current evidence on the prevalence and risk factors of intra-abdominal hypertension (IAH) to assist the decision-making for IAP monitoring.
IAH occurs in 20% to 40% of intensive care patients. High body mass index (BMI), abdominal surgery, liver dysfunction/ascites, hypotension/vasoactive therapy, respiratory failure and excessive fluid balance are risk factors of IAH in the general ICU population. IAP monitoring is strongly supported in mechanically ventilated patients with severe burns, severe trauma, severe acute pancreatitis, liver failure or ruptured aortic aneurysms. The risk of developing IAH is minimal in mechanically ventilated patients with positive end-expiratory pressure < 10 cmH2O, PaO2/FiO2 > 300, and BMI < 30 and without pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding or laparotomy and the use of vasopressors/inotropes on admission. In these patients, omitting IAP measurements might be considered.
In conclusions, clear guidelines to select the patients in whom IAP measurements should be performed cannot be given at present. In addition to IAP measurements in at-risk patients, a clinical assessment of the signs of IAH should be a part of every ICU patient's bedside evaluation, leading to prompt IAP monitoring in case of the slightest suspicion of IAH development.