Intra-abdominal hypertension in the critically ill: it is time to pay attention

Abstract

It is time to pay attention to intra-abdominal pressure in the critically ill. It is also time for standardized IAP measurement methods, good consensus definitions and randomized interventional studies.

Management of Peritonitis in the Critically Ill Patient

“…Furthermore, the aggressive resuscitation required in these patients causes gut and abdominal wall edema that may be associated with increased intra-abdominal pressure, worsened by a premature closing of the abdominal wall. To date, it is clear that the reduction of mortality below 20% has been the result of a better understanding of the role of damage control, prevention of intra-abdominal compartment syndrome, and improved antibiotic alternatives with broad-spectrum newer medications [5][6][7][8][9][10][11][12][13][14][15].…”

Intra-abdominal Hypertension and Abdominal Compartment Syndrome

“…26 Each measurement requires less than 2 minutes of nursing time, and the setup can be used for repetitive measurements for 2 to 3 weeks. 13,23,25 One drawback is that the stopcock system can be confusing, and if stopcock 3 is left in the off-to-drainage position after a measurement is obtained, urinary drainage will be obstructed. A patient safety concern with the specimen-port setup is that nurses must remember …”

“…10,12 If varices are present, this same pressure can lead to increased variceal stress and possible rupture. 13 With increased IAP, blood flow decreases in both the hepatic artery and the portal vein. This change in blood flow leads to decreased glucose metabolism, mitochondrial malfunction, and decreased lactate clearance by the liver.…”

“…2,11,13 The WSACS has developed a medical management algorithm 2,35 based on the causes of IAH and the condition of the patient. The algorithm is set up in an escalating stepwise approach (Figure 11- eschar and removal of constrictive abdominal dressings are advised.…”

Constipação intestinal em terapia intensiva

“…That is why, intestinal constipation could be related to increased duration of mechanical ventilation. (8,(10)(11) Nutritional causes Intestinal constipation may represent one facet of a major condition, dysfunction of intestinal motility. Patients who develop constipation often concomitantly present with gastroparesis and ileoparesia that delay the onset and hinder progression of nutritional support.…”