Abdominal Compartment Syndrome: Risk Factors, Diagnosis, and Current Therapy

Table 2

Bladder pressure monitoring guideline.

Patients covered
All ICU patients at risk for intra-abdominal hypertension.
Risk identifiers for increased intra-abdominal pressure (IAP):
(1) Damage control laparotomy.
(2) Intra-abdominal procedure in conjunction with large volume resuscitation (>10 liters crystalloid equivalent), or Coagulopathy requiring correction with the massive transfusion protocol, or Large volume blood component therapy (PRBC > 10 units, or FFP > 8 units).
(3) Severe sepsis or septic shock.
(4) Open body cavity.
(5) Core hypothermia.
(6) Cirrhosis or liver failure with ascites.
(7) Mechanical ventilation with PEEP > 10 cm H2O pressure (intrinsic or extrinsic).
(8) Physician discretion.
Definitions
(1) Intra-abdominal hypertension: IAP > 12 mm Hg.
(2) Abdominal compartment syndrome: a clinical syndrome resulting from increased IAP > 20 mm Hg coupled with an attributable organ failure manifested as increased peak airway pressure, oliguria, metabolic acidosis, decreased cardiac performance (mean arterial pressure, cardiac output, SvO2), decreased abdominal perfusion pressure, and decreased mentation. The ACS is commonly associated with IAP > 20 mm Hg but may occur at lower pressures as well based on individual patient characteristics.
(3) Abdominal perfusion pressure (APP): Mean arterial pressure (MAP)-(IAP); Normal APP > 60 mm Hg
Guideline
(1) On admission to the ICU, patients will be evaluated by the bedside nurse and the physician team for risk identifiers for increased IAP.
(2) Patients who are identified at-risk will be monitored by bladder pressure measurements according to the following schedule:
(a) On arrival to the SICU.
(b) Every 2 hours for the first 8 hours.
(c) Every 4 hours for the next 8 hours.
(d) Every 8 hours for the next 24 hours.
(3) The ICU bedside team (physician and nursing) will decide on the frequency on IAP measurements after the first 24 hours of monitoring.
(4) The physician team will be notified of all bladder pressure measurements >12 mm Hg and abdominal perfusion pressures < 60 mm Hg.
(5) These values will be recorded on the nursing record.