A Multicentre Survey of Paediatric Critical Care Nurses' Awareness, Knowledge and Practice of Intra-Abdominal
ZhiRu Li1,2, FangYan Lu1,3, YanHong Dai3
1Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Insights
Paediatric critical care nurses show significant gaps in knowledge and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Standardised training and guideline implementation are urgently needed for improved patient care.
Area of Science:
- Critical Care Medicine
- Pediatric Nursing
- Surgical Critical Care
Background:
- Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are critical conditions in pediatric patients.
- Nursing awareness, knowledge, and management of IAH/ACS are poorly understood.
- Effective management requires accurate intra-abdominal pressure (IAP) measurement.
Purpose of the Study:
- To evaluate pediatric critical care nurses' awareness, knowledge, and management practices regarding IAH/ACS.
- To assess nurses' understanding and application of intra-abdominal pressure (IAP) measurement techniques.
- To identify knowledge gaps, barriers, and facilitators for improving IAH/ACS care and standardizing IAP measurement.
Main Methods:
- A descriptive cross-sectional study surveyed pediatric critical care nurses online.
- The survey included 13 items on IAH/ACS awareness/knowledge and 12 items on IAP measurement practices.
- Data were collected from 235 nurses across nine settings in six hospitals in Zhejiang Province.
Main Results:
- Significant deficiencies were found in awareness and implementation of World Society of the Abdominal Compartment Syndrome (WSACS) guidelines.
- Many nurses lacked knowledge of IAH/ACS, its impact on organ function, and had no experience managing these conditions.
- IAP measurement training was limited, practices were unstandardized, and key barriers included skill deficits and inadequate indication recognition.
Conclusions:
- Substantial knowledge-practice gaps exist in pediatric IAH/ACS management, including low guideline awareness and inadequate IAP monitoring.
- There is an urgent need for standardized training on IAP monitoring and adoption of evidence-based guidelines.
- Enhancing stratified training, standardizing technical practices, and implementing guidelines are crucial for improving patient outcomes.
Background:
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are potentially life-threatening complications in critically ill children, yet nursing awareness, knowledge and management of these syndromes remain poorly understood.
Aim:
To assess paediatric critical care nurses' awareness, knowledge and management of IAH/ACS and intra-abdominal pressure (IAP) measurement, identifying gaps and barriers to guide training and protocol standardisation.
Study Design:
This is a descriptive cross-sectional study. Paediatric critical care nurses (convenience sample) from nine settings in six Zhejiang Province hospitals were surveyed online (April-May 2025). The survey evaluated IAH/ACS awareness/knowledge (13 items) and IAP measurement practices (12 items).
Results:
In this study, 235 nurses from nine centres responded (response rate: 61.8%). The survey revealed significant deficiencies in nurses' awareness and implementation of World Society of the Abdominal Compartment Syndrome (WSACS) guidelines: 52.8% were unaware of them, 12.3% reported familiarity, and 44.7% indicated non-adoption in their hospitals. Knowledge of IAH/ACS was limited: 54.9% had never heard of ACS, and 62.6% were unfamiliar with IAH's impact on organ function. Notably, 68.9% had never managed paediatric IAH/ACS cases. In practice, only 23.8% received IAP measurement training, and 26.0% had performed it. Transbladder measurement was most common (96.7%) but lacked standardisation. Main barriers were procedural skill deficits (61.5%), inadequate indication recognition (52.9%) and clinical inexperience (50.6%). Key facilitators included educational training (88.5%), simplified/standardised IAP techniques (88.1%) and evidence-based guidelines (80.4%).
Conclusions:
Substantial knowledge-practice gaps exist in paediatric IAH/ACS management, characterised by low guideline awareness, insufficient clinical knowledge and inadequate/unstandardised IAP monitoring. To address these gaps, efforts should prioritise enhancing stratified training, standardising technical practices and implementing guidelines.
Relevance To Clinical Practice:
There is an urgent need for paediatric critical care nurses to receive standardised training on IAP monitoring, to adopt unit-specific protocols and to lead or participate in the implementation of evidence-based guidelines at the bedside.
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