What’s new in medical management strategies for raised intra-abdominal pressure: evacuating intra-abdominal contents, improving abdominal wall compliance, pharmacotherapy, and continuous negative extra-abdominal pressure

Abstract

In the future, medical management may play an increasingly important role in the prevention and management of intra-abdominal hypertension (IAH). A review of different databases was used (PubMed, MEDLINE and EMBASE) with the search terms 'Intra-abdominal Pressure' (IAP), 'IAH' , ' Abdominal Compartment Syndrome' (ACS), 'medical management' and 'non-surgical management' . We also reviewed all papers with the search terms 'IAH' , 'IAP' and 'ACS' over the last three years, only extracting those papers which showed a novel approach in the non-surgical management of IAH and ACS. IAH and ACS are associated with increased morbidity and mortality. Non-surgical management is an important treatment option in critically ill patients with raised IAP. There are five medical treatment options to be considered to reduce IAP: 1) improvement of abdominal wall compliance; 2) evacuation of intra-luminal contents; 3) evacuation of abdominal fluid collections; 4) optimisation of fluid administration; and 5) optimisation of systemic and regional perfusion. This paper will review the first three treatment arms of the WSACS algorithm: abdominal wall compliance; evacuation of intra-luminal contents and evacuation of abdominal fluid collections. Emerging medical treatments will be analysed and finally some alternative specific treatments will be assessed. Other treatment options with regard to optimising fluid administration and systemic and regional perfusion will be described elsewhere, and are beyond the scope of this review. Medical management of critically ill patients with raised IAP should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Future studies are warranted to confirm some of these findings.

Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017

“…Less morbid therapies have been described to manage or prevent IAH without the need to proceed to a full decompressive laparotomy [36][37][38][39]. It is now possible that we may wish to have an open abdomen in the sickest septic patient not because we have to, but because we want to.…”

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

“…176 Cheatham, et al 177 demonstrated in a multicentre trial of 132 ventilated patients that IAP increased by 1.5 and 3.6 mm Hg when patients were placed in the semi-recumbent position at 15º and 30º HOB respectively. However, these differences were less obvious in patients with IAP>20 mm Hg.…”

Perspectives in Using Resonant Git Stimulation in Acute Pancreatitis

“…При паралитическом илеусе как одной из причин роста внутрибрюшного давления возможно применение лекар-ственной стимуляции, это доказывается успешным исполь-зованием ингибиторов ацетилхолинэстеразы [11][12][13][14][15][16]. Усилению перистальтики способствует также применение слабительных препаратов, что, однако, не находит своего отражения в доказательных исследованиях по лечению вну-трибрюшной гипертензии по данным литературы [17,18].…”