open access

Vol 47, No 1 (2015)
Review articles
Published online: 2014-11-24
Submitted: 2014-08-18
Accepted: 2014-10-22
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Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Adrian Regli, Bart De Keulenaer, Inneke De laet, Derek Roberts, Wojciech Dabrowski, Manu L.N.G. Malbrain
DOI: 10.5603/AIT.a2014.0067
·
Anaesthesiol Intensive Ther 2015;47(1):45-53.

open access

Vol 47, No 1 (2015)
Review articles
Published online: 2014-11-24
Submitted: 2014-08-18
Accepted: 2014-10-22

Abstract

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes.
With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population.

Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive
fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal
perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test.

Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

Abstract

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes.
With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population.

Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive
fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal
perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test.

Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

Get Citation

Keywords

intra-abdominal hypertension, Abdominal Compartment Syndrome, intra-abdominal pressure, fluid resuscitation, abdominal perfusion, fluid balance

About this article
Title

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47, No 1 (2015)

Pages

45-53

Published online

2014-11-24

DOI

10.5603/AIT.a2014.0067

Bibliographic record

Anaesthesiol Intensive Ther 2015;47(1):45-53.

Keywords

intra-abdominal hypertension
Abdominal Compartment Syndrome
intra-abdominal pressure
fluid resuscitation
abdominal perfusion
fluid balance

Authors

Adrian Regli
Bart De Keulenaer
Inneke De laet
Derek Roberts
Wojciech Dabrowski
Manu L.N.G. Malbrain

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