Intra-Abdominal Pressure Management in Critical Care

Elevated intra-abdominal pressure (IAP) represents a critical challenge in the management of critically ill patients, with intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) contributing to significant morbidity and mortality. IAP is influenced by factors such as fluid resuscitation volume, visceral oedema, and visceral space-occupying lesions. Persistent elevation impairs organ perfusion, leading to respiratory compromise, reduced cardiac output, renal dysfunction and gut ischaemia. Routine monitoring of IAP via bladder pressure measurement has become an essential vital sign in at-risk populations. Initial management focuses on non-operative interventions: optimisation of fluid balance, sedation and neuromuscular blockade to reduce abdominal wall tone, nasogastric and rectal decompression, and diuretics or renal replacement techniques to mobilise fluid. When these measures fail or ACS develops, prompt surgical decompression by laparostomy (open abdomen) is indicated. Temporary abdominal closure techniques, including negative pressure peritoneal therapy, facilitate source control and continuous fluid removal while protecting visceral contents. Restoration of normal physiology guides the timing of definitive primary fascial closure, balancing the risk of recurrent IAH against complications of prolonged open abdomen management. Recent advances emphasise tailored ventilatory strategies in the presence of IAH, the role of prophylactic open-abdomen approaches in selected vascular emergencies, and the evolution of device-agnostic negative pressure systems to improve outcomes.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Intra-Abdominal Pressure Management in Critical Care publication trend

The graph below shows the total number of articles in intra-abdominal pressure management in critical care across all publications each year (not limited to Nature Index journals).

Technical terms

Intra-abdominal pressure (IAP): The hydrostatic pressure within the abdominal cavity, measured in mmHg, reflecting the balance between intra-abdominal contents and the abdominal wall.

Intra-abdominal hypertension (IAH): Sustained or repeated IAP elevation above 12 mmHg, which can impair organ perfusion and function.

Abdominal compartment syndrome (ACS): A severe form of IAH characterised by IAP above 20 mmHg associated with new-onset organ dysfunction or failure.

Open abdomen (OA): A surgical approach in which the abdominal fascial edges are left unclosed to relieve pressure and facilitate source control.

Negative pressure peritoneal therapy (NPPT): A temporary abdominal closure technique that applies continuous negative pressure to evacuate peritoneal fluid and reduce IAP.

References

1. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Critical Care (2013).
2. Abdominal Compartment Syndrome: pathophysiology and definitions. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2009).
3. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Annals of Intensive Care (2019).
4. Increasing Use of Prophylactic Open Abdomen Therapy With Vacuum Assisted Wound Closure and Mesh Mediated Fascial Traction After Repair of Ruptured Abdominal Aortic Aneurysm. European Journal of Vascular and Endovascular Surgery (2023).
5. The unrestricted global effort to complete the COOL trial. World Journal of Emergency Surgery (2023).
6. The open abdomen in trauma and non-trauma patients: WSES guidelines. World Journal of Emergency Surgery (2018).