open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-11-20
Submitted: 2015-10-05
Accepted: 2015-11-17
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Methodological background and strategy for the 2012−2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society

Andrew W. Kirkpatrick, Derek J. Roberts, Roman Jaeschke, Jan J. De Waele, Bart L. De Keulenaer, Juan Duchesne, Martin Bjorck, Ari Leppäniemi, Janeth C. Ejike, Michael Sugrue, Michael L. Cheatham, Rao Ivatury, Chad G. Ball, Annika Reintam Blaser, Adrian Regli, Zsolt Balogh, Scott D'Amours, Inneke De laet, Manu L.N.G. Malbrain
DOI: 10.5603/AIT.a2015.0081

open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-11-20
Submitted: 2015-10-05
Accepted: 2015-11-17

Abstract

The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH/ /ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format. Scientific consultations were obtained from Methodological GRADE experts and a series of educational teleconferences were conducted to educate scientific review teams from among the wscacs. org membership. Each team conducted systematic or structured reviews to identify relevant studies and prepared evidence summaries and draft Grades of Recommendation Assessment, Development and Evaluation (GRADE) recommendations. The evidence and draft recommendations were presented and debated in person over four days. Updated consensus definitions and management statements were derived using a modified Delphi method. A writingcommittee subsequently compiled the results utilizing frequent Internet discussion and Delphi voting methods to compile a robust online Master Report and a concise peer-reviewed summarizing publication. A dedicated Paediatric Guidelines Subcommittee reviewed all recommendations and either accepted or revised them for appropriateness in children. Of the original 12 IAH/ACS definitions proposed in 2006, three (25%) were accepted unanimously, with four (33%) accepted by > 80%, and four (33%) accepted by > 50%, but required discussion to produce revised definitions. One (8%) was rejected by > 50%. In addition to previous 2006 definitions, the panel also defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, abdominal compliance, and suggested a refined open abdomen classification system. Recommendations were possible regarding intra-abdominal pressure (IAP) measurement, approach to sustained IAH, philosophy of protocolized IAP management and same-hospital-stay fascial closure, use of decompressive laparotomy, and negative pressure wound therapy. Consensus suggestions included use of non-invasive therapies for treating IAH/ACS, considering body position and IAP, damage control resuscitation, prophylactic open abdomen usage, and prudence in early biological mesh usage. No recommendations were made for the use of diuretics, albumin, renal replacement therapies, and utilizing abdominal perfusion pressure as a resuscitation-endpoint. Collaborating Methodological Guideline Development and Clinical Experts produced Consensus Definitions/Clinical Management statements encompassing the most contemporary evidence. Data summaries now exist for clinically relevant IAH/ACS questions, which will facilitate future scientific reanalysis.

Abstract

The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH/ /ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format. Scientific consultations were obtained from Methodological GRADE experts and a series of educational teleconferences were conducted to educate scientific review teams from among the wscacs. org membership. Each team conducted systematic or structured reviews to identify relevant studies and prepared evidence summaries and draft Grades of Recommendation Assessment, Development and Evaluation (GRADE) recommendations. The evidence and draft recommendations were presented and debated in person over four days. Updated consensus definitions and management statements were derived using a modified Delphi method. A writingcommittee subsequently compiled the results utilizing frequent Internet discussion and Delphi voting methods to compile a robust online Master Report and a concise peer-reviewed summarizing publication. A dedicated Paediatric Guidelines Subcommittee reviewed all recommendations and either accepted or revised them for appropriateness in children. Of the original 12 IAH/ACS definitions proposed in 2006, three (25%) were accepted unanimously, with four (33%) accepted by > 80%, and four (33%) accepted by > 50%, but required discussion to produce revised definitions. One (8%) was rejected by > 50%. In addition to previous 2006 definitions, the panel also defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, abdominal compliance, and suggested a refined open abdomen classification system. Recommendations were possible regarding intra-abdominal pressure (IAP) measurement, approach to sustained IAH, philosophy of protocolized IAP management and same-hospital-stay fascial closure, use of decompressive laparotomy, and negative pressure wound therapy. Consensus suggestions included use of non-invasive therapies for treating IAH/ACS, considering body position and IAP, damage control resuscitation, prophylactic open abdomen usage, and prudence in early biological mesh usage. No recommendations were made for the use of diuretics, albumin, renal replacement therapies, and utilizing abdominal perfusion pressure as a resuscitation-endpoint. Collaborating Methodological Guideline Development and Clinical Experts produced Consensus Definitions/Clinical Management statements encompassing the most contemporary evidence. Data summaries now exist for clinically relevant IAH/ACS questions, which will facilitate future scientific reanalysis.

Get Citation

Keywords

intra-abdominal hypertension, abdominal compartment syndrome, critical care, grades of recommendation, assessment, development, and evaluation criteria, evidence-based medicine, abdominal compartment society

About this article
Title

Methodological background and strategy for the 2012−2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47 (2015): Special issue

Pages

63-77

Published online

2015-11-20

DOI

10.5603/AIT.a2015.0081

Keywords

intra-abdominal hypertension
abdominal compartment syndrome
critical care
grades of recommendation
assessment
development
and evaluation criteria
evidence-based medicine
abdominal compartment society

Authors

Andrew W. Kirkpatrick
Derek J. Roberts
Roman Jaeschke
Jan J. De Waele
Bart L. De Keulenaer
Juan Duchesne
Martin Bjorck
Ari Leppäniemi
Janeth C. Ejike
Michael Sugrue
Michael L. Cheatham
Rao Ivatury
Chad G. Ball
Annika Reintam Blaser
Adrian Regli
Zsolt Balogh
Scott D'Amours
Inneke De laet
Manu L.N.G. Malbrain

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