Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome

To determine ICU registrars' level of awareness regarding measurement of intra-abdominal pressure (IAP), features of intra-abdominal hypertension (IAH), and management of abdominal compartment syndrome (ACS).

We surveyed 40 Australasian ICU registrars attending a post-graduate teaching course in 2004. The survey questions explored clinical experience and understanding of IAP, methods of measurement of IAP, diagnosis and causes of IAH and management of ACS in critically ill patients.

The survey recorded a 90% response rate. Ninety two percent of the ICU registrars had used IAP in their clinical practice; 52% of those with experience in IAP measurement had only employed it infrequently. While 90% affirmed their knowledge that IAP can rise due to intraperitoneal pathology, causation of IAH by retroperitoneal conditions was poorly understood. Ninety two per cent correctly said that ACS should be treated by abdominal decompression. Only 70% of our respondents felt confident not to perform a computed tomography (CT) scan of the abdomen before treating a patient with ACS. The majority understood the need for, and the modes of, therapy for ACS; but 33 % erroneously said that they would treat IAP > 30 mmHg regardless of organ dysfunction and another 22 % were unsure of the threshold of therapy for ACS.

ICU registrars in Australasia appreciate the techniques for, and significance of, IAP measurements and recognise and treat ACS appropriately. Retroperitoneal causes of IAH and the threshold for treatment for ACS were not well understood by the respondents.