IAH/ACS
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are common and connected with significant morbidity and mortality among critically ill adults (1-4). The World Society of abdominal compartment syndrome (WSACS) accord report in 2004 indicated that in the critically ill patient, the IAP is frequently elevated above patient’s normal baseline which is roughly 5 to 7 mmHg (1,3). Increased IAP or Intra-abdominal hypertension (IAH) described as a sustained or repeated pathological elevation in IAP of ≥ 12 mmHg (1,3) and acute compartment syndrome (ACS) defined as a sustained IAP > 20 mmHg ( with or without an APP < 60 mmHg) that is associated with new organ dysfunction failure have deleterious effects on end-organ function
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(1,5,6).
The situation turns more complicated when the patient at risk for IAH is being mechanically ventilated because under analgosedation and/or muscle relaxation, the typical signs and symptoms of complications could be concealed. These conditions can be very deleterious through the well known impacts of IAH on hemodynamics, respiratory and renal function, hepatosplanchnic perfusion and, therefore, the whole body could be aggravated by the use of mechanical ventilation (MV) per se (7,8).
On average, more than half of the patients admitted to different ICUs need MV. Mechanical ventilation itself can act as a inclining variable for the elevation of the IAP (7,9) in particular, when it is connected with the use of positive end-expiratory pressure (PEEP) or in the vicinity of auto-PEEP (10). The prevalence of IAH ranges from around one fourth to almost 50% of all patients and reaches 33% of mechanically ventilated patients (11-13). Yet, numerous members from the critical care team do not assess for IAH and are unaware of the outcomes of untreated IAH (14). These outcomes can be abdominal compartment syndrome (ACS), multisystem organ failure, and death (15, 16).
According to the literature, it is recommended that if two or more risk factors for IAH/ACS are present, a baseline IAP measurement should be obtained and if IAH is present, serial IAP measurements ought to be performed throughout the patient's critical illness (1).
For those patients with normal IAP, further measurement ought to be performed if the patient shows evidence of clinical deterioration or develops other risk factors for IAH (1).
The inquiries remain how exactly to recognize those at-risk patients, and whether our risk assessment is sufficiently exact. Numerous causal and predisposing factors are recorded in the consensus paper from the WSACS (1). However, this long list is difficult to apply by the critical care nurse at the bedside. More than one study has identified the high BMI, abdominal surgery, liver dysfunction/ ascites, hypotension/vasoactive therapy, respiratory failure and excessive fluid balance as risk factors of IAH in the mixed ICU populations. However, the precise prediction of IAH development in the mixed ICU populations remains difficult. Because of the tremendous impact of MV on the physiology of thoraco-abdominal interactions (10,11), it does not seem reasonable to assess IAH in a mixed population of MV and spontaneously breathing patients. Therefore the current study was led to identify predictors of increased IAP in mechanically ventilated
patients.
(1,5,6).
The situation turns more complicated when the patient at risk for IAH is being mechanically ventilated because under analgosedation and/or muscle relaxation, the typical signs and symptoms of complications could be concealed. These conditions can be very deleterious through the well known impacts of IAH on hemodynamics, respiratory and renal function, hepatosplanchnic perfusion and, therefore, the whole body could be aggravated by the use of mechanical ventilation (MV) per se (7,8).
On average, more than half of the patients admitted to different ICUs need MV. Mechanical ventilation itself can act as a inclining variable for the elevation of the IAP (7,9) in particular, when it is connected with the use of positive end-expiratory pressure (PEEP) or in the vicinity of auto-PEEP (10). The prevalence of IAH ranges from around one fourth to almost 50% of all patients and reaches 33% of mechanically ventilated patients (11-13). Yet, numerous members from the critical care team do not assess for IAH and are unaware of the outcomes of untreated IAH (14). These outcomes can be abdominal compartment syndrome (ACS), multisystem organ failure, and death (15, 16).
According to the literature, it is recommended that if two or more risk factors for IAH/ACS are present, a baseline IAP measurement should be obtained and if IAH is present, serial IAP measurements ought to be performed throughout the patient's critical illness (1).
For those patients with normal IAP, further measurement ought to be performed if the patient shows evidence of clinical deterioration or develops other risk factors for IAH (1).
The inquiries remain how exactly to recognize those at-risk patients, and whether our risk assessment is sufficiently exact. Numerous causal and predisposing factors are recorded in the consensus paper from the WSACS (1). However, this long list is difficult to apply by the critical care nurse at the bedside. More than one study has identified the high BMI, abdominal surgery, liver dysfunction/ ascites, hypotension/vasoactive therapy, respiratory failure and excessive fluid balance as risk factors of IAH in the mixed ICU populations. However, the precise prediction of IAH development in the mixed ICU populations remains difficult. Because of the tremendous impact of MV on the physiology of thoraco-abdominal interactions (10,11), it does not seem reasonable to assess IAH in a mixed population of MV and spontaneously breathing patients. Therefore the current study was led to identify predictors of increased IAP in mechanically ventilated
patients.