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Ventilator-Associated Pneumonia in Patients With Increased Intra-abdominal Pressure
Christos Doudakmanis1,2, Demosthenes Makris1
1Department of Critical Care Medicine, University Hospital of Larissa, Larissa, GRC.
Cureus
|April 28, 2025
Summary
Elevated intra-abdominal pressure (IAP) increases the risk of ventilator-associated pneumonia (VAP) in ICU patients. Managing IAP is crucial for preventing difficult-to-treat infections and adverse events.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- Increased intra-abdominal pressure (IAP) is a significant clinical concern associated with adverse patient events.
- Respiratory infections, particularly ventilator-associated pneumonia (VAP), are a major problem in intensive care units (ICUs).
- Patients on prolonged mechanical ventilation are especially susceptible to VAP due to factors like extended hospitalization, prior antibiotic use, and comorbidities.
Purpose of the Study:
- To review the existing literature on the relationship between elevated IAP and the development of VAP in mechanically ventilated patients.
- To explore how elevated IAP contributes to VAP development through mechanisms like microaspiration and compromised intestinal barrier function.
- To highlight the increased risk of multidrug-resistant VAP in critically ill patients with elevated IAP.
Main Methods:
- Literature review of available studies on IAP and VAP in mechanically ventilated patients.
- Analysis of the impact of elevated IAP on pulmonary function, hemodynamics, and immune status.
- Examination of the microbiological profile shifts and treatment challenges associated with multidrug-resistant VAP.
Main Results:
- Elevated IAP is linked to an increased risk of microaspirations and altered intestinal barrier integrity, contributing to VAP.
- Elevated IAP can worsen pulmonary function and hemodynamic stability, further increasing VAP risk.
- Critically ill patients with elevated IAP face a higher risk of systemic infections, organ failure, and multidrug-resistant VAP.
Conclusions:
- Elevated IAP is an important, modifiable factor in the development of VAP in mechanically ventilated patients.
- Comprehensive strategies are needed in ICUs to mitigate risks associated with both elevated IAP and multidrug-resistant VAP.
- Timely intervention and proper management of elevated IAP can prevent difficult-to-treat infections and life-threatening adverse events.
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