A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients
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Intra-abdominal hypertension (IAH) is common and associated with morbidity and mortality in critically ill patients. IAH exists along a continuum that begins with a mild asymptomatic elevation of intra-abdominal pressure (IAP) and extends to life-threatening abdominal compartment syndrome (ACS). In 2013, evidence-based guidelines were published on the definitions, diagnosis, and treatment of IAH and ACS. Even using these guidelines, making bedside decisions regarding management of individual patients with IAH/ACS remains challenging due to the wide variety of conditions associated with IAH/ACS, the varying degrees of associated organ dysfunction, and the large number of available treatment options. Using a simplified treatment paradigm, we advocate that the optimal treatment strategy should not be based purely on the degree of IAP alone, but on three critical elements: the magnitude of IAP, the degree and dynamics of organ dysfunction (or thus the impact of increased IAP), and the etiology of increased IAP. In this chapter, we propose a conceptual framework of how to diagnose and manage patients with IAH/ACS, taking into account patient physiology, current scientific evidence, and experience. In this practical and clinical approach, both the necessity and urgency of intervention are discussed.
KeywordsIntra-abdominal hypertension Abdominal compartment syndrome Intra-abdominal pressure Abdominal Abdomen
The authors would like to thank Drs. Bart De Keulenaer, Chialka Ejike, Adrian Regli, Annika Reintam, Andrew Kirkpatrick, and Derek Roberts for their contributions to this manuscript.
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