open access

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

Bart De Keulenaer, Adrian Regli, Inneke De laet, Derek Roberts, Manu L.N.G. Malbrain
DOI: 10.5603/AIT.a2014.0065
·
Anaesthesiol Intensive Ther 2015;47(1):54-62.

open access

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

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.

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.

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Keywords

intra-abdominal hypertension, Abdominal Compartment Syndrome, non-surgical management, intra- -abdominal pressure, medical management, neuromuscular blockers, gastric evacuation, paracenthesis, pharmacotherapy

About this article
Title

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

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47, No 1 (2015)

Pages

54-62

Published online

2014-11-24

DOI

10.5603/AIT.a2014.0065

Bibliographic record

Anaesthesiol Intensive Ther 2015;47(1):54-62.

Keywords

intra-abdominal hypertension
Abdominal Compartment Syndrome
non-surgical management
intra- -abdominal pressure
medical management
neuromuscular blockers
gastric evacuation
paracenthesis
pharmacotherapy

Authors

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

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