Is it wise not to think about intraabdominal hypertension in the ICU?
OBJECTIVE
This review focuses on the available literature published in the past 2 years. MEDLINE and PubMed searches were performed using intraabdominal pressure, intraabdominal hypertension, and abdominal compartment as search items. The aim was to find an answer to the question: "Is it wise not to measure or even not to think about intraabdominal hypertension in ICU?"


RESULTS
It is difficult to find a good gold standard for intraabdominal pressure measurement. Bladder pressure can be used as an intraabdominal pressure estimate provided it is measured in a reproducible way. Automated continuous intraabdominal pressure monitoring has recently become available. Key messages are (1). body mass index and fluid resuscitation are independent predictors of intraabdominal hypertension; (2). intraabdominal hypertension increases intrathoracic, intracranial, and intracardiac filling pressures; (3). transmural or transabdominal filling pressures combined with volumetric parameters better reflect preload; (4). volumetric target values need to be corrected for baseline ejection fractions; (5). intraabdominal hypertension decreases left ventricular, chest wall and total respiratory system compliance; (6). best positive end-expiratory pressure can be set to counteract intraabdominal pressure; (7). acute respiratory distress syndrome definitions should take into account best positive end-expiratory pressure and intraabdominal pressure but not wedge pressure; (8). lung protective strategies should aim at deltaPplat (plateau pressure - intraabdominal pressure); (9). intraabdominal hypertension causes atelectasis and increases extravascular lung water; (10). intraabdominal hypertension is an independent predictor of acute renal failure; (11). monitoring of abdominal perfusion pressure can be useful; and (12). intraabdominal hypertension triggers bacterial translocation and multiple organ system failure.


CONCLUSIONS
The answer is that it is unwise not to measure intraabdominal pressure in the ICU or even not to think about it.
Malbrain
Manu L N G
ML
Medical ICU, ACZA Campus Stuivenberg, Antwerpen, Belgium. manu.malbrain@skynet.be
D000005:Abdomen / Q000503:physiopathology*; D000818:Animals; D003161:Compartment Syndromes / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000379:methods; D011312:Pressure; D015995:Prevalence