Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2016; 5(1): 96-102
Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.96
Mild to moderate intra-abdominal hypertension: Does it matter?
Liivi Maddison, Joel Starkopf, Annika Reintam Blaser
Liivi Maddison, Joel Starkopf, Annika Reintam Blaser, Department of Anaesthesiology and Intensive Care, University of Tartu, 51014 Tartu, Estonia
Liivi Maddison, Joel Starkopf, Department of Anaesthesiology and Intensive Care, Tartu University Hospital, 51014 Tartu, Estonia
Annika Reintam Blaser, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
Author contributions: All authors contributed to the concept of the manuscript; Maddison L drafted the manuscript; Starkopf J and Reintam Blaser A made critical revisions related to important intellectual content of the manuscript; all authors approved the final version of the manuscript.
Supported by the Ministry of Education and Research of Estonia (IUT34-24).
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Annika Reintam Blaser, MD, PhD, Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014 Tartu, Estonia. annika.reintam.blaser@ut.ee
Telephone: +37-25-142281 Fax: +37-25-142281
Received: August 29, 2015
Peer-review started: September 6, 2015
First decision: October 27, 2015
Revised: November 18, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: February 4, 2016
Processing time: 147 Days and 11 Hours
Abstract

This review summarizes the epidemiology, pathophysiological consequences and impact on outcome of mild to moderate (Grade I to II) intra-abdominal hypertension (IAH), points out possible pitfalls in available treatment recommendations and focuses on tasks for future research in the field. IAH occurs in about 40% of ICU patients. Whereas the prevalence of abdominal compartment syndrome seems to be decreasing, the prevalence of IAH does not. More than half of IAH patients present with IAH grade I and approximately a quarter with IAH grade II. However, most of the studies have addressed IAH as a yes-or-no variable, with little or no attention to different severity grades. Even mild IAH can have a negative impact on tissue perfusion and microcirculation and be associated with an increased length of stay and duration of mechanical ventilation. However, the impact of IAH and its different grades on mortality is controversial. The influence of intra-abdominal pressure (IAP) on outcome most likely depends on patient and disease characteristics and the concomitant macro- and microcirculation. Therefore, management might differ significantly. Today, clear triggers for interventions in different patient groups with mild to moderate IAH are not defined. Further studies are needed to clarify the clinical importance of mild to moderate IAH identifying clear triggers for interventions to lower the IAP.

Keywords: Intra-abdominal pressure; Intra-abdominal hypertension; Pathophysiology; Epidemiology; Severity; Treatment

Core tip: This review summarizes the epidemiology, pathophysiological consequences and impact on outcome of mild to moderate intra-abdominal hypertension (IAH) and focuses on tasks for future research in the field. More than half of IAH patients present with IAH Grade I  and approximately a quarter with IAH grade II. Even mild IAH can have a negative impact on tissue perfusion and be associated with impaired clinical outcomes. However, the impact of IAH and its different grades on mortality is controversial. Clear triggers for interventions in different patient groups with mild to moderate IAH are not defined.