Intra-Abdominal Hypertension and MODS

  • Jan J. De WaeleEmail author
  • Inneke De laet


Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been rediscovered in the last decades, and appear to frequently complicate severe sepsis and septic shock. IAH affects all organ systems and contributes to the development of MODS. Intra-abdominal pressure measurement is therefore mandatory as IAP should be incorporated in the clinical management of hemodynamics and respiration, and used as a therapeutic target. Comprehensive management of IAH in the critically ill patient is based on recognition of the problem, prevention where possible, and medical and surgical treatment when indicated. In this review, we will give an overview of the current understanding of IAH and ACS in general, and explore how it is relevant for severe sepsis patients and their treatment.


Septic Shock Severe Sepsis Abdominal Compartment Syndrome Pulse Pressure Variation Stroke Volume Variation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Balogh Z, De Waele JJ, Malbrain ML (2007) Continuous intra-abdominal pressure monitoring. Acta Clin Belg Suppl (1):26–32Google Scholar
  2. Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1997) A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 25:496–503PubMedCrossRefGoogle Scholar
  3. Burchard KW, Ciombor DM, McLeod MK, Slothman GJ, Gann DS (1985) Positive end expiratory pressure with increased intra-abdominal pressure. Surg Gynecol Obstet 161:313–318PubMedGoogle Scholar
  4. Chaves N Jr, Magalhaes Lde T, Colleoni R, Del Grande JC (2007) Effects of increased intra-abdominal pressure on the healing process after surgical stapling of the stomach of dogs. Acta Cir Bras 22:379–386PubMedGoogle Scholar
  5. Cheatham M, Malbrain M (2006) Cardiovascular implications of elevated intra-abdominal pressure. In: Ivatury R, Cheatham M, Malbrain M, Sugrue M (eds) Abdominal compartment syndrome. Landes Bioscience, Georgetown, pp 89–104Google Scholar
  6. Citerio G, Vascotto E, Villa F, Celotti S, Pesenti A (2001) Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 29:1466–1471PubMedCrossRefGoogle Scholar
  7. Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N (2008) Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 34:707–713PubMedCrossRefGoogle Scholar
  8. De Keulenaer BL, De Waele JJ, Powell B, Malbrain ML (2009) What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med 35:969–976PubMedCrossRefGoogle Scholar
  9. De Laet IE, Hoste EA, De Waele JJ (2007) Survey on the perception and management of the abdominal compartment syndrome among Belgian surgeons. Acta Chir Belg 107:648–652PubMedGoogle Scholar
  10. De Waele JJ, De laet I, Malbrain ML (2007) Rational intraabdominal pressure monitoring: how to do it? Acta Clin Belg Suppl (1):16–25Google Scholar
  11. Deeren D, Dits H, Malbrain MLNG (2005) Correlation between intra-abdominal and intracranial pressure in nontraumatic brain injury. Intensive Care Med 31:1577–1581PubMedCrossRefGoogle Scholar
  12. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30:536–555PubMedCrossRefGoogle Scholar
  13. Diebel LN, Dulchavsky SA, Brown WJ (1997) Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 43:852–855PubMedCrossRefGoogle Scholar
  14. Doty JM, Oda J, Ivatury RR, Blocher CR, Christie GE, Yelon JA, Sugerman HJ (2002) The effects of hemodynamic shock and increased intra-abdominal pressure on bacterial translocation. J Trauma 52:13–17PubMedCrossRefGoogle Scholar
  15. Duperret S, Lhuillier F, Piriou V, Vivier E, Metton O, Branche P, Annat G, Bendjelid K, Viale JP (2007) Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med 33(1):163–171, Epub 2006 Nov 11PubMedCrossRefGoogle Scholar
  16. Ejike JC, Humbert S, Bahjri K, Mathur M (2007) Outcomes of children with abdominal compartment syndrome. Acta Clin Belg Suppl (1):141–148Google Scholar
  17. Ivatury R, Diebel L (2006) Intra-abdominal hypertension and the splanchnic bed. In: Ivatury R, Cheatham M, Malbrain M, Sugrue M (eds) Abdominal compartment syndrome. Landes Bioscience, Georgetown, pp 129–137Google Scholar
  18. Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36:815–818; discussion 818–819PubMedCrossRefGoogle Scholar
  19. Kashtan J, Green JF, Parsons EQ, Holcroft JW (1981) Hemodynamic effect of increased abdominal pressure. J Surg Res 30:249–255PubMedCrossRefGoogle Scholar
  20. Kimball EJ, Rollins MD, Mone MC, Hansen HJ, Baraghoshi GK, Johnston C, Day ES, Jackson PR, Payne M, Barton RG (2006) Survey of intensive care physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome. Crit Care Med 34:2340–2348PubMedCrossRefGoogle Scholar
  21. Kologlu M, Sayek I, Kologlu LB, Onat D (1999) Effect of persistently elevated intraabdominal pressure on healing of colonic anastomoses. Am J Surg 178:293–297PubMedCrossRefGoogle Scholar
  22. Kula R, Szturz P, Sklienka P, Neiser J (2008) Negative fluid balance in patients with abdominal compartment syndrome–case reports. Acta Chir Belg 108:346–349PubMedGoogle Scholar
  23. Malbrain ML (2004) Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 30:357–371PubMedCrossRefGoogle Scholar
  24. Malbrain ML, Cheatham ML (2004) Cardiovascular effects and optimal preload markers in intra-abdominal hypertension. In: Vincent J-L (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin, pp 519–543Google Scholar
  25. Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829PubMedCrossRefGoogle Scholar
  26. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L (2005a) Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33:315–322PubMedCrossRefGoogle Scholar
  27. Malbrain ML, Deeren D, De Potter TJ (2005b) Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 11:156–171PubMedCrossRefGoogle Scholar
  28. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2006) Results from the International Conference of Experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med 32:1722–1732PubMedCrossRefGoogle Scholar
  29. Malbrain ML, De laet I, Van Regenmortel N, Schoonheydt K, Dits H (2009) Can the abdominal perimeter be used as an accurate estimation of intra-abdominal pressure? Crit Care Med 37:316–319PubMedCrossRefGoogle Scholar
  30. Mullens W, Abrahams Z, Francis GS, Taylor DO, Starling RC, Tang WH (2008) Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure. J Card Fail 14:508–514PubMedCrossRefGoogle Scholar
  31. Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK (1991) Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol 70:2611–2618PubMedGoogle Scholar
  32. Oda J, Ueyama M, Yamashita K, Inoue T, Noborio M, Ode Y, Aoki Y, Sugimoto H (2006) Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. J Trauma 60:64–71PubMedCrossRefGoogle Scholar
  33. O’Mara MS, Slater H, Goldfarb IW, Caushaj PF (2005) A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma 58:1011–1018PubMedCrossRefGoogle Scholar
  34. Pelosi P, Quintel M, Malbrain ML (2007) Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg Suppl (1):78–88Google Scholar
  35. Regueira T, Bruhn A, Hasbun P, Aguirre M, Romero C, Llanos O, Castro R, Bugedo G, Hernandez G (2008) Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock. J Crit Care 23:461–467PubMedCrossRefGoogle Scholar
  36. Reintam A, Parm P, Kitus R, Kern H, Starkopf J (2008) Primary and secondary intra-abdominal hypertension–different impact on ICU outcome. Intensive Care Med 34:1624–1631PubMedCrossRefGoogle Scholar
  37. Renner J, Gruenewald M, Quaden R, Hanss R, Meybohm P, Steinfath M, Scholz J, Bein B (2009) Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model*. Crit Care Med 37(2):650–658PubMedCrossRefGoogle Scholar
  38. Richardson JD, Trinkle JK (1976) Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res 20:401–404PubMedCrossRefGoogle Scholar
  39. Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M, Stewart A, Hillman K, Deane SA (2002) Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 26:1428–1431PubMedCrossRefGoogle Scholar
  40. Vidal MG, Ruiz Weisser J, Gonzalez F, Toro MA, Loudet C, Balasini C, Canales H, Reina R, Estenssoro E (2008) Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med 36:1823–1831PubMedCrossRefGoogle Scholar
  41. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D, Sepsis Occurrence in Acutely Ill Patients Investigators (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRefGoogle Scholar
  42. Yagci G, Zeybek N, Kaymakcioglu N, Gorgulu S, Tas H, Aydogan MH, Avci IY, Cetiner S (2005) Increased intra-abdominal pressure causes bacterial translocation in rabbits. J Chin Med Assoc 68:172–177PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Critical Care MedicineGhent University HospitalGhentBelgium
  2. 2.ICUZiekenhuisNetwerk AntwerpenAntwerpBelgium

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