The abdominal compartment syndrome. Clinical relevance

Area of Science:

• Critical Care Medicine
• Physiology
• Surgical Critical Care

Background:

• Increased intra-abdominal pressure (IAP) is a recognized complication in various clinical scenarios encountered by intensivists.
• Evidence suggests elevated IAP can negatively impact cardiac, renal, respiratory, and metabolic functions.
• Despite its potential severity, IAP is often underdiagnosed and undertreated in Intensive Care Unit (ICU) settings.

Purpose of the Study:

• To review methods for measuring IAP in the ICU.
• To discuss the physiopathological consequences of elevated IAP.
• To present clinical data on IAP in critically ill patients.

Main Methods:

• Review of available literature and clinical data on intra-abdominal pressure measurement and its effects.
• Discussion of various techniques for estimating IAP at the bedside.
• Analysis of existing clinical data regarding IAP in critically ill populations.

Main Results:

• Multiple bedside techniques exist for estimating IAP.
• Elevated IAP (10-20 cmH2O) is common in ICU patients, indicating abdominal hypertension (IAH) in most and abdominal compartment syndrome (ACS) in a few.
• Increased IAP affects multiple organ systems, including respiratory, hemodynamic, renal, gut, and brain functions, and correlates with severity scores, though its link to mortality is debated.

Conclusions:

• Bedside methods for estimating IAP are available and reliable.
• Elevated IAP is prevalent in critically ill patients and impacts various organ systems.
• Routine IAP measurement via bladder pressure does not increase the risk of urinary tract infections.