2013 Nov – Intra-abdominal Hypertension in Medical Critically Ill Patients. A narrative review

Intra-abdominal Hypertension/ Abdominal Compartment Syndrome (IAH/ACS) is a well-recognized entity among surgical sub-specialties. Nevertheless, it has been proven to be present in the medical critically ill population…

Prospective and retrospective observational studies have found medical patients with IAH/ACS to be associated with death in the Intensive Care Unit (ICU) and other poor outcomes. Frequently, it is under-diagnosed and under-treated in this patient group. Limitations encountered in these observational studies are their small population size and single-center design. In addition, most studies target consecutive ICU admissions instead of limiting IAH/ACS screening to a pre-defined population confined by their risk factors (unspecified ascites, mechanical ventilation, positive fluid balance, etc). Generally, medical patients with IAH/ACS are more severely ill compared to surgical patients. Furthermore, they are less likely to receive treatment targeted at lowering intra-abdominal pressure. Medical treatment of IAH/ACS has not being demonstrated to be specifically effective to avoid decompressive surgery. Identifying medical patients-at-risk of IAH represents an under-researched area for which training in measurement of abdominal pressure surrogates, awareness of its prevalence, prevention and treatment of such condition could further improve outcomes in critically ill medical patients.

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