Elevated intra-abdominal pressure: A review of current knowledge

Abstract

Elevated intra-abdominal pressure (IAP) is a known cause of increased morbidity and mortality among critically ill patients. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure. Raised IAP affects every system and main organ in the human body. Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery. Yet, despite being so common, this potentially lethal condition often goes unnoticed. In 2004, the World Society of the Abdominal Compartment Syndrome, an international multidisciplinary consensus group, was formed to provide unified definitions, improve understanding and promote research in this field. Simple, reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management. The correct, structured approach to treatment can have a striking effect and fully restore homeostasis. In recent years, significant progress has been made in this area with the contribution of surgeons, internal medicine specialists and anesthesiologists. Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis, monitoring and treatment of this life-threatening condition.

Keywords: Abdominal compartment syndrome; Intra-abdominal hypertension; Intra-abdominal pressure; Multiple organ failure; Abdominal perfusion pressure

Core Tip: Elevated intra-abdominal pressure is a common, life-threatening condition associated with increased morbidity and mortality. Unrecognized intra-abdominal hypertension (IAH) quickly leads to the development of multiple organ failure; therefore, vigilance is necessary in relation to high-risk patients. Monitoring bladder pressure in this group allows early recognition of IAH/abdominal compartment syndrome and timely intervention which can have a striking effect and fully restore homeostasis. Although the progress made in recent years is significant, there are still open questions which leave room for future research.