Intra-abdominal hypertension and abdominal compartment syndrome: the journey forward

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are recognized causes of significant morbidity and mortality among a wide variety of critically ill patient populations. Our understanding of IAH and ACS as causes of organ failure and patient death has increased significantly over the past two decades since their "rediscovery" as clinically important disease processes. The development of consensus definitions and recommendations for the diagnosis and management of IAH/ACS, patient care algorithms, an international clinical research working group, and other educational tools have advanced efforts to improve patient outcome. Nonoperative management strategies to reduce elevated intra-abdominal pressure (IAP) and early surgical intervention for refractory IAH/ACS have been demonstrated to significantly improve patient survival. It is only through such a comprehensive, goal-directed approach that patient outcome will continue to improve. Despite the significant advances that have been made, the journey toward conquering IAH/ACS as a cause of patient death after injury and/or illness has only just begun. It is remarkable to consider that two decades ago, IAH, the detrimental physiological effects of elevated IAP and ACS, the development of IAH-induced organ dysfunction and failure were essentially unrecognized as causes of morbidity and mortality among critically ill adult and pediatric patients. It is not because these disease processes have been recently discovered. The pathophysiological impact of elevated IAP on cardiac, pulmonary, and renal function was well defined over 150 years ago. It has only been within the past 15 years that physicians and nurses worldwide rediscovered this long-forgotten pathophysiological knowledge and began to actively reconsider these two disease processes in their patient's daily differential diagnosis. Originally considered diseases affecting solely the traumatically injured, IAH and ACS are now recognized to occur in both medical and surgical patients of any age and to result from a wide range of injuries and disease processes. Tremendous progress has been made in recent years with regard to our understanding of the diagnosis and management of IAH and ACS. Within this special supplement of The American Surgeon, you will find a series of "state-of-the-art" reviews authored by a number of the world's experts on IAH/ACS as well as abstracts of research that will be presented at the Fifth World Congress on the Abdominal Compartment Syndrome (Lake Buena Vista, Florida, August 10-13, 2011). This commentary will review where we were, where we are today, and where we are going with respect to the future of IAH and ACS.