open access

Vol 46, No 5 (2014 Nov-Dec)
Review articles
Submitted: 2014-11-28
Accepted: 2014-11-28
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The role of abdominal compliance, the neglected parameter in critically ill patients — a consensus review of 16. Part 1: definitions and pathophysiology

Manu L.N.G. Malbrain, Derek J. Roberts, Inneke De laet, Jan J. De Waele, Michael Sugrue, Alexander Schachtrupp, Juan Duchesne, Gabrielle Van Ramshorst, Bart De Keulenaer, Andrew W. Kirkpatrick, Siavash Ahmadi-Noorbakhsh, Jan Mulier, Rao Ivatury, Francisco Pracca, Robert Wise, Paolo Pelosi
DOI: 10.5603/AIT.2014.0062
·
Anaesthesiol Intensive Ther 2014;46(5):392-405.

open access

Vol 46, No 5 (2014 Nov-Dec)
Review articles
Submitted: 2014-11-28
Accepted: 2014-11-28

Abstract

Over the last few decades, increasing attention has been paid to understanding the pathophysiology, aetiology, prognosis, and treatment of elevated intra-abdominal pressure (IAP) in trauma, surgical, and medical patients. However, there is presently a relatively poor understanding of intra-abdominal volume (IAV) and the relationship between IAV and IAP (i.e. abdominal compliance). Consensus definitions on Cab were discussed during the 5th World Congress on Abdominal Compartment Syndrome and a writing committee was formed to develop this article. During the writing process, a systematic and structured Medline and PubMed search was conducted to identify relevant studies relating to the topic. According to the recently updated consensus definitions of the World Society on Abdominal Compartment Syndrome (WSACS), abdominal compliance (Cab) is defined as a measure of the ease of abdominal expansion, which is determined by the elasticity of the abdominal wall and diaphragm. It should be expressed as the change in IAV per change in IAP (mL [mm Hg]-1). Importantly, Cab is measured differently than IAP and the abdominal wall (and its compliance) is only a part of the total abdominal pressure-volume (PV) relationship. During an increase in IAV, different phases are encountered: the reshaping, stretching, and pressurisation phases. The first part of this review article starts with a comprehensive list of the different definitions related to IAP (at baseline, during respiratory variations, at maximal IAV), IAV (at baseline, additional volume, abdominal workspace, maximal and unadapted volume), and abdominal compliance and elastance (i.e. the relationship between IAV and IAP). An historical background on the pathophysiology related to IAP, IAV and Cab follows this. Measurement of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The Cab is one of the most neglected parameters in critically ill patients, although it plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion. The definitions presented herein will help to understand the key mechanisms in relation to Cab and clinical conditions and should be used for future clinical and basic science research. Specific measurement methods, guidelines and recommendations for clinical management of patients with low Cab are published in a separate review.

Abstract

Over the last few decades, increasing attention has been paid to understanding the pathophysiology, aetiology, prognosis, and treatment of elevated intra-abdominal pressure (IAP) in trauma, surgical, and medical patients. However, there is presently a relatively poor understanding of intra-abdominal volume (IAV) and the relationship between IAV and IAP (i.e. abdominal compliance). Consensus definitions on Cab were discussed during the 5th World Congress on Abdominal Compartment Syndrome and a writing committee was formed to develop this article. During the writing process, a systematic and structured Medline and PubMed search was conducted to identify relevant studies relating to the topic. According to the recently updated consensus definitions of the World Society on Abdominal Compartment Syndrome (WSACS), abdominal compliance (Cab) is defined as a measure of the ease of abdominal expansion, which is determined by the elasticity of the abdominal wall and diaphragm. It should be expressed as the change in IAV per change in IAP (mL [mm Hg]-1). Importantly, Cab is measured differently than IAP and the abdominal wall (and its compliance) is only a part of the total abdominal pressure-volume (PV) relationship. During an increase in IAV, different phases are encountered: the reshaping, stretching, and pressurisation phases. The first part of this review article starts with a comprehensive list of the different definitions related to IAP (at baseline, during respiratory variations, at maximal IAV), IAV (at baseline, additional volume, abdominal workspace, maximal and unadapted volume), and abdominal compliance and elastance (i.e. the relationship between IAV and IAP). An historical background on the pathophysiology related to IAP, IAV and Cab follows this. Measurement of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The Cab is one of the most neglected parameters in critically ill patients, although it plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion. The definitions presented herein will help to understand the key mechanisms in relation to Cab and clinical conditions and should be used for future clinical and basic science research. Specific measurement methods, guidelines and recommendations for clinical management of patients with low Cab are published in a separate review.

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Keywords

abdominal pressure, abdominal volume, abdominal compliance, abdominal wall, pressure volume relation, diagnosis, treatment, abdominal hypertension, abdominal compartment, laparoscopy, risk factors

About this article
Title

The role of abdominal compliance, the neglected parameter in critically ill patients — a consensus review of 16. Part 1: definitions and pathophysiology

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 46, No 5 (2014 Nov-Dec)

Pages

392-405

DOI

10.5603/AIT.2014.0062

Bibliographic record

Anaesthesiol Intensive Ther 2014;46(5):392-405.

Keywords

abdominal pressure
abdominal volume
abdominal compliance
abdominal wall
pressure volume relation
diagnosis
treatment
abdominal hypertension
abdominal compartment
laparoscopy
risk factors

Authors

Manu L.N.G. Malbrain
Derek J. Roberts
Inneke De laet
Jan J. De Waele
Michael Sugrue
Alexander Schachtrupp
Juan Duchesne
Gabrielle Van Ramshorst
Bart De Keulenaer
Andrew W. Kirkpatrick
Siavash Ahmadi-Noorbakhsh
Jan Mulier
Rao Ivatury
Francisco Pracca
Robert Wise
Paolo Pelosi

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