Special Issue "Intra-abdominal Hypertension and Abdominal Compartment Syndrome"

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: 31 October 2023 | Viewed by 11547

Special Issue Editors

Professor Critical Care Research, First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego street 8, 20-954 Lublin, Poland
Interests: abdominal pressure; abdominal hypertension; abdominal compartment; monitoring; hemodynamics; ventilation; critical care; ICU; sepsis; fluids
Dr. Ashish Kumar Khanna
E-Mail Website
Co-Guest Editor
Vice Chair for Research, Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA
Interests: hemodynamic monitoring; perioperative outcomes; vasoactive use in the ICU; prediction and prevention of hypotension; big data analytics

Special Issue Information

Dear Colleagues,

Unlike many commonly encountered disease processes, which remain within the purview of a given discipline, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) readily cross the usual barriers and may occur in any patient population, regardless of age, illness, or injury. As a result, no one scientific society or association can represent the wide variety of physicians, nurses, respiratory therapists, and other allied healthcare personnel who might encounter patients with IAH and/or ACS in their daily practice. To fill this void, the Abdominal Compartment Society (formerly known as the World Society on Abdominal Compartment Syndrome (WSACS, www.wsacs.org)) has been founded to serve as a peer-reviewed forum and educational resource for all healthcare providers, as well as industries, who have an interest in IAH and ACS. The mission of the WSACS is to foster education, promote research, and thereby improve the survival of patients with IAH and ACS by bringing together physicians, nurses, and others from throughout the world and from a variety of clinical disciplines.

We invite investigators to contribute original research articles or review articles that will stimulate continuing efforts to understand the etiology, epidemiology, pathophysiology and management of patients with IAH and ACS. We are particularly interested in articles describing the effects of new modalities for the clinical and surgical management of IAH and ACS, as well as the long-term effects of these treatments on patient outcome and quality of life. We also welcome animal research on the pathophysiologic and molecular mechanisms of IAH and ACS.

Potential topics include, but are not limited to:

  • Definitions and guidelines;
  • New measurement techniques for intra-abdominal pressure (IAP): bladder vs. gastric vs. other noninvasive measurement techniques;
  • Epidemiology and risk factors for IAH;
  • How to measure intraabdominal volume and abdominal wall compliance;
  • Relationship between body anthropometric data, central obesity, body mass index and IAP;
  • IAH and pregnancy;
  • IAH and other diseases: kidney disease, heart failure, hematologic complications, neurological disorders, etc.;
  • Organ–organ crosstalk;
  • Abdominal sepsis and severe acute pancreatitis;
  • Imaging in ACS: the role for ultrasound or CT;
  • Cardiovascular effects of IAH (in particular the role of barometric vs. volumetric preload indicators, fluid responsiveness and cardiac ultrasound);
  • Renal effects of IAH (the role of abdominal perfusion pressure and filtration gradient, or the role of biomarkers such as NGAL or cystatin C in IAH);
  • Central nervous system effects of IAH (and polycompartment syndrome);
  • Effects of IAH on hepatosplanchnic perfusion (indocyanine green clearance, gastric tonometry, etc.);
  • Respiratory effects of IAH (VILI, recruitment, PV loops, best PEEP, transpulmonary pressures, etc.);
  • Medical management (improvement of abdominal wall compliance, evacuation of abdominal fluid collections, evacuation of intraluminal contents, correction of capillary leak and fluid management);
  • Primary vs. secondary IAH;
  • Recurrent IAH;
  • Surgical management: decompressive laparotomy, open abdomen, temporary abdominal closure, vacuum-assisted closure.

Prof. Dr. Manu Malbrain
Dr. Ashish Kumar Khanna
Guest Editors

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Keywords

  • abdominal pressure
  • abdominal hypertension
  • abdominal compartment syndrome
  • IAP measurement
  • complications
  • definitions
  • guidelines
  • monitoring
  • treatment

Published Papers (7 papers)

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Research

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Article
Evaluation of Intra-Abdominal Hypertension Parameters in Patients with Acute Pancreatitis
Life 2023, 13(6), 1227; https://doi.org/10.3390/life13061227 - 23 May 2023
Viewed by 378
Abstract
Background: Patients with acute pancreatitis develop numerous complications and organ damage due to increased intra-abdominal pressure (IAP). These extrapancreatic complications determine the clinical outcome of the disease. Materials and methods: A total of 100 patients with acute pancreatitis were included in the prospective [...] Read more.
Background: Patients with acute pancreatitis develop numerous complications and organ damage due to increased intra-abdominal pressure (IAP). These extrapancreatic complications determine the clinical outcome of the disease. Materials and methods: A total of 100 patients with acute pancreatitis were included in the prospective cohort study. Observed patients were divided into two groups according to their mean values of IAP (normal IAP values and elevated IAP values), which were compared with examined variables. Patients with intra-abdominal hypertension (IAH) were divided into four groups by IAP values, and those groups of patients were also compared with the examined variables. Results: Differences between body mass index (BMI) (p = 0.001), lactates (p = 0.006), and the Sequential Organ Failure Assessment (SOFA) score (p = 0.001) were statistically significant within all examined IAH groups. Differences between the mean arterial pressure (MAP) (p = 0.012) and filtration gradient (FG) (p < 0.001) were statistically significant between the first and second IAH groups in relation to the fourth. Differences in diuresis per hour (p = 0.022) showed statistical significance in relation to the first and third groups of IAH patients. Conclusions: Changes in IAP values lead to changes in basic vital parameters MAP, APP, FG, diuresis per hour, and lactate levels in patients with acute pancreatitis. Early recognition of changes in the SOFA score accompanying an increase in the IAP value is essential. Full article
(This article belongs to the Special Issue Intra-abdominal Hypertension and Abdominal Compartment Syndrome)
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Article
Hands off Trans-Femoral Venous Intra-Abdominal Pressure Estimates in Children: Results of a Sobering Single-Center Study
Life 2023, 13(4), 872; https://doi.org/10.3390/life13040872 - 24 Mar 2023
Viewed by 548
Abstract
Background: For a long time, trans-femoral venous pressure (FVP) measurement was considered a simple alternative for estimating intra-abdominal pressure (IAP). Since intravesical [IVP] and intragastric [IGP] pressure measurements are sometimes contraindicated for anatomical and pathophysiological reasons, FVP raised hopes, especially among pediatricians. Pediatric [...] Read more.
Background: For a long time, trans-femoral venous pressure (FVP) measurement was considered a simple alternative for estimating intra-abdominal pressure (IAP). Since intravesical [IVP] and intragastric [IGP] pressure measurements are sometimes contraindicated for anatomical and pathophysiological reasons, FVP raised hopes, especially among pediatricians. Pediatric FVP validation studies have never been published; recent results from adult studies cast doubt on their interchangeability. Therefore, we compared for the first time the measurement agreement between FVP and IVP and IGP in children. Material and methods: We prospectively compared FVP with IVP and IGP, according to the Abdominal Compartment Society validation criteria. Additionally, we analyzed the agreement as a function of IAP or right heart valve regurgitation and pulmonary hypertension. Results: In a real-life PICU study design, n = 39 children were included (median age 4.8 y, LOS-PICU 23 days, PRISM III score 11). In n = 660 FVP–IGP measurement pairs, the median IAP was 7 (range 1 to 23) mmHg; in n = 459 FVP–IVP measurement pairs, the median IAP was 6 (range 1to 16) mmHg. The measurement agreement was extremely low with both established methods (FVP–IGP: r2 0.13, mean bias −0.8 ± 4.4 mmHg, limits of agreement (LOA) −9.6/+8.0, percentage error (PE) 55%; FVP–IVP: r2 0.14, bias +0.5 ± 4.2 mmHg, limit of agreement (LOA) −7.9/+8.9, percentage error (PE) 51%). No effect of the a priori defined influencing factors on the measurement agreement could be demonstrated. Conclusions: In a study cohort with a high proportion of critically ill children suffering from IAH, FVP did not agree reliably with either IVP or IGP. Its clinical use in critically ill children must therefore be strongly discouraged. Full article
(This article belongs to the Special Issue Intra-abdominal Hypertension and Abdominal Compartment Syndrome)
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Article
A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring
Life 2022, 12(12), 1950; https://doi.org/10.3390/life12121950 - 22 Nov 2022
Viewed by 1125
Abstract
Objective: A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). DESIGN: Eight-year retrospective before and after [...] Read more.
Objective: A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). DESIGN: Eight-year retrospective before and after study (2015–2022). Setting: A single American Burn Association-verified Burn Center with 14 inpatient beds. Patients: Patients meeting criteria for admission to a Burn Center. Methods: Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015–December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Patients were transferred from outside hospitals with gravity bladder. A distinction in the chart between catheter types was impossible. Charts were reviewed to characterize patients with CAUTI events. Results: A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (p < 0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017–0.294). Conclusions: CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients. Full article
(This article belongs to the Special Issue Intra-abdominal Hypertension and Abdominal Compartment Syndrome)
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Article
Pre-Clinical Validation of A Novel Continuous Intra-Abdominal Pressure Measurement Equipment (SERENNO)
Life 2022, 12(8), 1161; https://doi.org/10.3390/life12081161 - 30 Jul 2022
Cited by 4 | Viewed by 1398
Abstract
Introduction: Increased intra-abdominal pressure (IAP) has an important impact on morbidity and mortality in critically ill patients. The SERENNO Sentinel system (Serenno Medical, Yokne’am Illit, Israel) is a novel device that allows automatic and continuous IAP measurements. Aims: Pre-clinical validation in a bench [...] Read more.
Introduction: Increased intra-abdominal pressure (IAP) has an important impact on morbidity and mortality in critically ill patients. The SERENNO Sentinel system (Serenno Medical, Yokne’am Illit, Israel) is a novel device that allows automatic and continuous IAP measurements. Aims: Pre-clinical validation in a bench model study comparing the new device with the gold standard method and two other continuous IAP measurement devices. Methods: IAP measurement with the novel SERENNO device (IAPSER) was compared with the gold standard IAPH2O (water column height) and two other automatic and continuous IAP measurement devices: IAPCiM measured via the CiMON device (Pulsion Medical Systems, Munich, Germany) and IAPSPIE measured using the Spiegelberg device (Spiegelberg, Hamburg, Germany), which previously received the CE mark for clinical applications. The IAP measurement was performed six times (n = 6) at each pressure value (between 0 and 35 mmHg) with different methods and the height of the water column in a bench-top phantom was used as the reference IAP for further interpretations. In addition to the quadruple comparisons, intra- and inter-observer variability of IAP measurements were also calculated. Correlation studies and Bland and Altman’s analyses were performed in addition to the concordance study. Results: The CiMON and Spiegelberg devices showed a greater dynamic range and standard deviation when recording IAPCiM and IAPSPIE compared with IAPSER. In general, the maximum and minimum values of IAP recorded with each device (at each level of IAPH2O) were significantly different from each other. However, the average values were in very good agreement. The highest correlation was observed between IAPSER and IAPH2O, and IAPSER and IAPSPIE (R = 0.99, p = 0.001 for both comparisons and intra- and inter-observer measurements). Although the CiMON and SERENNO systems were in very good agreement with each other, a slightly smaller correlation coefficient was found between them (R = 0.95, p = 0.001, and R = 0.96, p = 0.001 for intra- and inter-observer measurements, respectively). When compared to the gold standard (IAPH2O), Bland and Altman’s analysis showed a mean difference of +0.44, −0.25, and −0.04 mmHg for the intra-observer measurements and +0.18, −0.75, and −0.58 mmHg for the inter-observer measurements for IAPSER, IAPCiM, and IAPSPIE, respectively. IAPSER showed a small positive bias (overestimation), while IAPCiM and IAPSPIE showed a negative bias (underestimation) when compared to IAPH2O. Further statistical analysis showed a concordance coefficient of 100% with an excellent ability of the SERENNO system in tracking IAPH2O changes. Conclusions: Pre-clinical validation of a new IAP monitoring device (SERENNO) showed very promising results when compared with the gold standard and other continuous techniques; however, clinical trials should be followed as the next stage of the validation process. Based on the actual research guidelines, the SERENNO system can be used interchangeably with the gold standard. Full article
(This article belongs to the Special Issue Intra-abdominal Hypertension and Abdominal Compartment Syndrome)
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Review

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Review
Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome
Life 2023, 13(2), 330; https://doi.org/10.3390/life13020330 - 24 Jan 2023
Viewed by 701
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high morbidity and mortality. Obesity may result in increased intra-abdominal pressure (IAP) and affect clinical outcomes of patients with IAH and/or ACS. This study aims to establish the impact of obesity on [...] Read more.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high morbidity and mortality. Obesity may result in increased intra-abdominal pressure (IAP) and affect clinical outcomes of patients with IAH and/or ACS. This study aims to establish the impact of obesity on the clinical outcomes of IAH and ACS patients. A systematic search of Medline, Embase, and Scopus was performed in August 2022. Nine studies comprising 9938 patients were included. There were 65.1% males (n = 6250/9596). Patient demographics, comorbidities, and morbidities were analyzed in correlation with obesity and IAP. Obese patients had a higher risk of IAH (OR 8.5, p < 0.001). Obesity was associated with the need for renal replacement therapy, intensive care unit-acquired infections, systemic inflammatory response syndrome, acute respiratory distress syndrome, length of hospital stay, and mortality. This review highlights the lacunae in the existing literature to underpin the direct impact of obesity, independent of obesity-associated comorbidities, on the clinical outcomes of IAH and ACS. Full article
(This article belongs to the Special Issue Intra-abdominal Hypertension and Abdominal Compartment Syndrome)
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Review
Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review
Life 2022, 12(9), 1390; https://doi.org/10.3390/life12091390 - 06 Sep 2022
Cited by 7 | Viewed by 5280
Abstract
Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal [...] Read more.
Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS). Methods: We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH. Results: We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality. Conclusions: Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial. Full article
(This article belongs to the Special Issue Intra-abdominal Hypertension and Abdominal Compartment Syndrome)
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Other

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Brief Report
Assessment of Intra-Abdominal Pressure with a Novel Continuous Bladder Pressure Monitor—A Clinical Validation Study
Life 2023, 13(2), 384; https://doi.org/10.3390/life13020384 - 30 Jan 2023
Viewed by 630
Abstract
Introduction: Intra-abdominal hypertension and the resulting abdominal compartment syndrome are serious complications of severely ill patients. Diagnosis requires an intra-abdominal pressure (IAP) measurement, which is currently cumbersome and underused. We aimed to test the accuracy of a novel continuous IAP monitor. Methods: Adults [...] Read more.
Introduction: Intra-abdominal hypertension and the resulting abdominal compartment syndrome are serious complications of severely ill patients. Diagnosis requires an intra-abdominal pressure (IAP) measurement, which is currently cumbersome and underused. We aimed to test the accuracy of a novel continuous IAP monitor. Methods: Adults having laparoscopic surgery and requiring urinary catheter intra-operatively were recruited to this single-arm validation study. IAP measurements using the novel monitor and a gold-standard foley manometer were compared. After anesthesia induction, a pneumoperitoneum was induced through a laparoscopic insufflator, and five randomly pre-defined pressures (between 5 and 25 mmHg) were achieved and simultaneously measured via both methods in each participant. Measurements were compared using Bland–Altman analysis. Results: In total, 29 participants completed the study and provided 144 distinct pairs of pressure measurements that were analyzed. A positive correlation between the two methods was found (R2 = 0.93). There was good agreement between the methods, with a mean bias (95% CI) of −0.4 (−0.6, −0.1) mmHg and a standard deviation of 1.3 mmHg, which was statistically significant but of no clinical importance. The limits of agreement (where 95% of the differences are expected to fall) were −2.9 and 2.2 mmHg. The proportional error was statistically insignificant (p = 0.85), suggesting a constant agreement between the methods across the range of values tested. The percentage error was 10.7%. Conclusions: Continuous IAP measurements using the novel monitor performed well in the clinical setup of controlled intra-abdominal hypertension across the evaluated range of pressures. Further studies should expand the range to more pathological values. Full article
(This article belongs to the Special Issue Intra-abdominal Hypertension and Abdominal Compartment Syndrome)
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