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 2: measurement techniques and management recommendations

Manu L.N.G. Malbrain, 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, Paolo Pelosi, Rao Ivatury, Francisco Pracca, Marcelo David, Derek J. Roberts
DOI: 10.5603/AIT.2014.0063
·
Anaesthesiol Intensive Ther 2014;46(5):406-432.

open access

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

Abstract

The recent definitions on intra-abdominal pressure (IAP), intra-abdominal volume (IAV) and abdominal compliance (Cab) are a step forward in understanding these important concepts. They help our understanding of the pathophysiology, aetiology, prognosis, and treatment of patients with low Cab. However, there is still a relatively poor understanding of the different methods used to measure IAP, IAV and Cab and how certain conditions may affect the results. This review will give a concise overview of the different methods to assess and estimate Cab; it will list important conditions that may affect baseline values and suggest some therapeutic options. Abdominal compliance (Cab), defined as a measure of the ease of abdominal expansion, is measured differently than IAP. The compliance of the abdominal wall is only a part of the total abdominal pressure-volume (PV) relationship. Measurement or estimation of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The different measurement techniques will be discussed in relation to decreases (ascites drainage, haematoma evacuation, gastric suctioning) or increases in IAV (gastric insufflation, laparoscopy with CO2 pneumoperitoneum, peritoneal dialysis). More specific techniques using the interactions between the thoracic and abdominal compartment during positive pressure ventilation will also be discussed (low flow PV loop, respiratory IAP variations, respiratory abdominal variation test, mean IAP and abdominal pressure variation), together with the concept of the polycompartment model. The relation between IAV and IAP is linear at low IAV and becomes curvilinear and exponential at higher volumes. Specific conditions in relation to increased (previous pregnancy or laparoscopy, gynoid fat distribution, ellipse-shaped internal abdominal perimeter) or decreased Cab (obesity, fluid overload, android fat distribution, sphere-shaped internal abdominal perimeter) will be discussed as well as their impact on baseline IAV, IAP, reshaping capacity and abdominal workspace volume. Finally, we suggest possible treatment options in situations of unadapted IAV according to existing Cab, which results in high IAP. A large overlap exists between the treatment of patients with abdominal hypertension and those with low Cab. The Cab plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion and function. If we can identify patients with low Cab, we can anticipate and select the most appropriate surgical treatment to avoid complications such as IAH or ACS.

Abstract

The recent definitions on intra-abdominal pressure (IAP), intra-abdominal volume (IAV) and abdominal compliance (Cab) are a step forward in understanding these important concepts. They help our understanding of the pathophysiology, aetiology, prognosis, and treatment of patients with low Cab. However, there is still a relatively poor understanding of the different methods used to measure IAP, IAV and Cab and how certain conditions may affect the results. This review will give a concise overview of the different methods to assess and estimate Cab; it will list important conditions that may affect baseline values and suggest some therapeutic options. Abdominal compliance (Cab), defined as a measure of the ease of abdominal expansion, is measured differently than IAP. The compliance of the abdominal wall is only a part of the total abdominal pressure-volume (PV) relationship. Measurement or estimation of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The different measurement techniques will be discussed in relation to decreases (ascites drainage, haematoma evacuation, gastric suctioning) or increases in IAV (gastric insufflation, laparoscopy with CO2 pneumoperitoneum, peritoneal dialysis). More specific techniques using the interactions between the thoracic and abdominal compartment during positive pressure ventilation will also be discussed (low flow PV loop, respiratory IAP variations, respiratory abdominal variation test, mean IAP and abdominal pressure variation), together with the concept of the polycompartment model. The relation between IAV and IAP is linear at low IAV and becomes curvilinear and exponential at higher volumes. Specific conditions in relation to increased (previous pregnancy or laparoscopy, gynoid fat distribution, ellipse-shaped internal abdominal perimeter) or decreased Cab (obesity, fluid overload, android fat distribution, sphere-shaped internal abdominal perimeter) will be discussed as well as their impact on baseline IAV, IAP, reshaping capacity and abdominal workspace volume. Finally, we suggest possible treatment options in situations of unadapted IAV according to existing Cab, which results in high IAP. A large overlap exists between the treatment of patients with abdominal hypertension and those with low Cab. The Cab plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion and function. If we can identify patients with low Cab, we can anticipate and select the most appropriate surgical treatment to avoid complications such as IAH or ACS.

Get Citation

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 2: measurement techniques and management recommendations

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 46, No 5 (2014 Nov-Dec)

Pages

406-432

DOI

10.5603/AIT.2014.0063

Bibliographic record

Anaesthesiol Intensive Ther 2014;46(5):406-432.

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
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
Paolo Pelosi
Rao Ivatury
Francisco Pracca
Marcelo David
Derek J. Roberts

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