MONITORING INTRABDOMINAL PRESSURE Something Old , Something New , Something Borrowed ...

Systematic interest in intraabdominal pressure began about two decades ago. Since than, the amount of scientific data regarding this problem have been risen exponentially. This happened due to several reasons: description of pathophysiological pathways which link intra-abdominal hypertension (IAH) to multiple organ dysfunction syndrome refinement of measurement techniques, emergence of national, international and worldwide scientific organizations dedicated to IAH and the dramatic increase in body of published papers dealing with this topic. The critical mass of this accumulation was reached and the explosive dissemination of data bursted. Intra-abdominal hypertension is defined as sustained or repeated pathological elevation in intra-abdominal pressure (IAP) ≥ 12 mmHg. Abdominal compartment syndrome (ACS) is defined as sustained IAP ≥ 20 mmHg associated with new organ dysfunction. Three types of ACS were described: primary ACS, caused by a disease in the abdomino-pelvic area, secondary ACS, caused by conditions which do not originate in this region, usually associated with sepsis/systemic inflammatory response syndrome and/or aggressive fluid resuscitation, and recurrent ACS. Measurement of intra-abdominal pressure changed over time regarding techniques and indications, as well. Measurement techniques changed from urinary, gastric or rectal catheter to intravascular (inferior vena cava) evaluation, from large volume to low volume bladder instillation, and special devices were developed and marketed, as a response of companies to increasing interest. Indications for intra-abdominal pressure monitoring were changed, also. Initially indicated in case of abdominal trauma or severe abdominal emergencies (abdominal aorta aneurysm repair, e.g.), than indicated in intra-abdominal/extra-abdominal sepsis, nowadays intra-abdominal pressure monitoring is recommended in nearly all types of critical illness (trauma, surgical and medical). Measurement of IAP should be routine as monitoring of blood pressure, heart rate, temperature, respiratory rate, peripheral oxygen saturation, central venous pressure, and urinary output. What caused this dramatic change of indications? There are several responsible factors: the documented association between IAH and mortality, the description of pathophysiological consequences of IAH and ACS, the association with aggressive fluid resuscitation and/or sepsis and shock, the influence on treatment strategy and the documented interrelation with other compartment syndromes. Let’s talk a little bit about them!