title: Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome.
abstract: OBJECTIVE
  To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS).
  
  
  METHODS
  We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. Quality of evidence was graded from high (A) to very low (D) and management statements from strong RECOMMENDATIONS (desirable effects clearly outweigh potential undesirable ones) to weaker SUGGESTIONS (potential risks and benefits of the intervention are less clear).
  
  
  RESULTS
  In addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation.
  
  
  CONCLUSIONS
  Although IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.
authors.affiliation: The Departments of Surgery and Critical Care Medicine and Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, T2N 2T9, Canada. Andrew.kirkpatrick@albertahealthservices.ca
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: Jan
authors.initials: J
authors.lastname: De Waele
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Manu L N G
authors.initials: ML
authors.lastname: Malbrain
authors.forename: Bart
authors.initials: B
authors.lastname: De Keulenaer
authors.forename: Juan
authors.initials: J
authors.lastname: Duchesne
authors.forename: Martin
authors.initials: M
authors.lastname: Bjorck
authors.forename: Ari
authors.initials: A
authors.lastname: Leppaniemi
authors.forename: Janeth C
authors.initials: JC
authors.lastname: Ejike
authors.forename: Michael
authors.initials: M
authors.lastname: Sugrue
authors.forename: Michael
authors.initials: M
authors.lastname: Cheatham
authors.forename: Rao
authors.initials: R
authors.lastname: Ivatury
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Annika
authors.initials: A
authors.lastname: Reintam Blaser
authors.forename: Adrian
authors.initials: A
authors.lastname: Regli
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
authors.forename: Scott
authors.initials: S
authors.lastname: D'Amours
authors.forename: Dieter
authors.initials: D
authors.lastname: Debergh
authors.forename: Mark
authors.initials: M
authors.lastname: Kaplan
authors.forename: Edward
authors.initials: E
authors.lastname: Kimball
authors.forename: Claudia
authors.initials: C
authors.lastname: Olvera
mesh_terms: D000328:Adult; D000465:Algorithms; D002648:Child; D003697:Delphi Technique; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000628:therapy*; D012307:Risk Factors; D009626:Terminology as Topic