Intraabdominal hypertension and abdominal compartment syndrome: What you need to know

Abdominal hypertension is a pathologic elevation in intraabdominal pressure most often seen in critically ill patients with propensity for progression to abdominal compartment syndrome once organ dysfunction develops. Intraabdominal hypertension alone is an independent predictor of morbidity and mortality, but progression to abdominal compartment syndrome portends a worse prognosis with extremely high mortality rates, even after treatment. Pathologic increases in intraabdominal pressure can cause physiologic changes impacting multiple organ systems both directly and indirectly, which may lead to rapid patient deterioration. As such, critical care providers must be able to identify high risk patients in order to effectively monitor intraabdominal pressure and to provide expeditious, appropriate treatment for these patients when warranted. While the diagnosis of abdominal compartment syndrome is clinical, the sensitivity of physical examination alone is low, and at risk patients should undergo intraabdominal pressure monitoring with bladder pressures measured every 4 hours. Changes in intraabdominal pressure or organ function and the time over which these changes develop dictate treatment choice. Management strategies for intraabdominal hypertension focus on reduction of intraabdominal volume, increasing abdominal wall compliance, and optimizing fluid balance, which is a nuanced practice in critically ill patients. There are a multitude of treatment options which may be employed to address the spectrum of intraabdominal hypertension, which ranges from asymptomatic elevations in intraabdominal pressure to overt abdominal compartment syndrome requiring emergent decompression. The step-up management approach suggests beginning with less invasive supportive and medical therapies and escalating as appropriate to procedural, then surgical interventions if necessary to reduce pathologically elevated intraabdominal pressure. To improve patient outcomes, critical care providers must be adept at identifying patients requiring intraabdominal pressure monitoring, recognizing and addressing physiologic changes associated with intraabdominal hypertension, and managing the condition effectively to prevent the potentially catastrophic consequences of abdominal compartment syndrome.