It's high time for intra‐abdominal hypertension guidelines in pregnancy after more than 100 years of measuring pressures

Lozada, M. James; Goyal, Varun; Osmundson, Sarah S.; Pacheco, Luis D.; Malbrain, Manu L N G

doi:10.1111/aogs.13697

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…During pregnancy, IAP rises due to the growing uterus, fluid status and tissue mass. From the 2nd trimester onward, IAP values are measured within the range of IAH in non-pregnant individuals [4,12,[28][29][30][31]. A pregnant woman seems to cope very well via a process of extraordinary physiologic adaptation.…”

Section: Increase In Iap During Pregnancy Might Induce Venous Congestmentioning

confidence: 99%

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

Dreesen

Schoutteten

Velde

et al. 2020

JCM

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Intra-abdominal hypertension (IAH) causes severe organ dysfunction. Our aim is to evaluate the effect of increased intra-abdominal pressure (IAP) on renal function, hypothesizing that venous congestion may increase proteinuria and fluid retention without endothelial dysfunction. Three urine samples were collected from 32 non-pregnant women undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) and from 10 controls placed in Trendelenburg position for 60 min. Urine sampling was done before (PRE), during or immediately after (PER), and two hours after (POST) the procedure. Urinary albumin, protein and creatinine concentrations were measured in each sample, and ratios were calculated and compared within and between groups. During LAVH, the albumin/creatinine ratio (ACR) increased and persisted POST-procedure, which was not observed in controls. A positive correlation existed between the LAVH duration and the relative change in both ACR and protein/creatinine ratio (PCR) PER- and POST-procedure. Iatrogenic IAH increases urinary ACR and PCR in non-pregnant women via a process of venous congestion. This mechanism might explain the presentation of one specific subtype of late-onset preeclampsia, where no drop of maternal cardiac output is observed.

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Section: Increase In Iap During Pregnancy Might Induce Venous Congestmentioning

confidence: 99%

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

Dreesen

Schoutteten

Velde

et al. 2020

JCM

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“…One review found that IAP in individuals with a normal weight was around 5-6 mmHg, whereas it was much higher in obese patients with values above 12 mmHg and even above 14 mmHg in morbid obesity [16]. Other conditions associated with "physiologically" increased IAP include pregnancy [18] and liver cirrhosis with ascites [19]. Although this chronic IAP elevation may contribute to chronic forms of organ failure, including chronic kidney failure in patients with congestive heart disease and obesity [20] or pseudotumor cerebri in patients with obesity [21], slight increases from a higher starting value may have limited implications in critically ill patients.…”

Section: Baseline Iap Value and Dynamicsmentioning

confidence: 99%

A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients

2020

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“…Obese patients have higher baseline IAP values, some with values even higher than the threshold for IAH of 12 mm Hg [ 5 ]. Liver cirrhosis with ascites [ 6 ] and pregnancy [ 7 ] have inherently elevated IAP. A meta-analysis review by Hershberger et al recommends the need for abdominal pressure monitoring in burn cases with greater than 30% total burn surface area (TBSA) along with early therapeutic maneuvers such as sedation and paralysis, escharotomies, or changes in fluid management may be performed to prevent ACS [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Development of Early Abdominal Compartment Syndrome Leading to Emergent Decompressive Laparotomy in Full-Thickness Burn Injury

et al. 2022

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Burn injuries carry an increased risk of intra-abdominal hypertension and are an independent risk factor for abdominal compartment syndrome (ACS). ACS is most commonly due to large volume resuscitation. The added concern of ACS can complicate resuscitative efforts. Early monitoring for ACS (intra-abdominal pressure > 20 mm Hg with associated new-onset organ dysfunction) and performing prudent decompressive laparotomies are important factors to keep in mind when treating large surface area burn patients. This case report describes the hospitalization of a 60-year-old male who presented with 45% fullthickness (FT) total body surface area (TBSA) and inhalation injury. On arrival to the emergency department (ED), he had received a total of 6 L of intravenous lactate Ringers, and vasopressors were initiated due to hypotension. During the tertiary examination it was noted that there was increased difficulty ventilating the patient, and his abdomen was becoming increasingly distended and tense. His intra-abdominal pressure was measured in the ED and found to be elevated at 32 mm Hg. The findings were suggestive of ACS and a decompressive laparotomy was performed in the ED. Upon entering the abdominal cavity, the abdominal contents extruded through the incision and diffuse venous congestion and gastric distention were noted. Items commonly found in operating rooms (Top-Draper ® warmer drape, Kerlix rolls, Jackson-Pratt suction drains, and 3M ® Ioban sterile antimicrobial incise drape) were utilized to maintain an open abdomen where abdominal contents could easily be observed and to prevent delay in performing a decompressive laparotomy. Here we describe a patient with 45% FT TBSA and inhalation injuries requiring an emergent decompressive laparotomy for ACS after only 6 L of lactate Ringers were administered. This highlights the importance of early monitor-ing for ACS and the ease of performing a decompressive laparotomy with commonly found items in the ED and operating rooms.

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It's high time for intra‐abdominal hypertension guidelines in pregnancy after more than 100 years of measuring pressures

Cited by 4 publications

References 4 publications

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients

Development of Early Abdominal Compartment Syndrome Leading to Emergent Decompressive Laparotomy in Full-Thickness Burn Injury

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