Awareness, knowledge and practices related to intra-abdominal hypertension and abdominal compartment syndrome among intensive care providers: a systematic scoping review

Annals of Intensive Care volume 15, Article number: 106, Published: 24 July 2025

Abstract

Objectives

To provide a comprehensive overview of current research on intensive care providers’ awareness, knowledge, and practices regarding IAP/IAH/ACS, as well as barriers to IAP measurement.

Methods

This scoping review was guided by the framework of Arksey and Malley. Eight databases were searched to identify research published after 2007, including MEDLINE Complete, EMBASE, Web of Science, Cochrane Library, CINAHL Complete, ProQuest Health & Medical Complete, CNKI, and WANFANG. Two researchers reviewed and screened potentially relevant studies based on title and abstract. Full-text articles were independently assessed for eligibility based on predefined inclusion criteria.

Results

Nineteen articles were included. Overall, pediatric intensive care providers demonstrated a lower awareness and knowledge of IAH/ACS compared to adult intensive care providers, particularly regarding the consensus definitions of IAH/ACS in critically ill children. IAP measurement has not been adequately integrated into clinical practice, with 18.0–73.0% of intensive care providers reporting they have never measured it. The frequency of IAP measurements and the criteria for determining which patients necessitate such measurements exhibited significant variability across different hospitals. The most frequently mentioned barriers to IAP measurement include a lack of knowledge regarding IAP measurement among adult intensivists, an overreliance on physical examination among pediatric intensivists, uncertainty in interpreting IAP data among adult intensive care nurses, and challenges in identifying populations at high risk of IAH among pediatric intensive care nurses. Diuretics were mentioned most often in the management of IAH/ACS, followed by administration of vasopressors and inotropes, decompressive laparotomy, and judicious administration of fluids and blood products. 37.0–66.3% of adult intensivists would choose a decompressive laparotomy in cases of ACS, whereas pediatric intensivists were less inclined to opt for the same approach.

Conclusions

Since the publication of the WSACS consensus in 2007, there has been an improvement in awareness and knowledge regarding IAP/IAH/ACS among intensive care providers. Nevertheless, the understanding of the consensus definitions regarding IAH/ACS remains inadequate, particularly among pediatric intensive care providers. It is imperative to advocate for the implementation of WSACS guidelines in hospitals through targeted training programs and to promote the routine practice of IAP measurement in clinical settings.

 

Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis

 

by Wenhua He, Peng Chen, Yupeng Lei, Liang Xia, Pi Liu, Yong Zhu, Hao Zeng, Yao Wu, Huajing Ke, Xin Huang, Wenhao Cai, Xin Sun, Wei Huang, Robert Sutton, Yin Zhu and Nonghua Lu 

 

Critical Care volume 26, Article number: 52 (2022) Published: 03 March 2022

 

 

Background

Intra-abdominal hypertension (IAH) in acute pancreatitis (AP) is associated with deterioration in organ function. This trial aimed to assess the efficacy of neostigmine for IAH in patients with AP.

Methods

In this single-center, randomized trial, consenting patients with IAH within 2 weeks of AP onset received conventional treatment for 24 h. Patients with sustained intra-abdominal pressure (IAP) ≥ 12 mmHg were randomized to receive intramuscular neostigmine (1 mg every 12 h increased to every 8 h or every 6 h, depending on response) or continue conventional treatment for 7 days. The primary outcome was the percent change of IAP at 24 h after randomization.

Results

A total of 80 patients were recruited to neostigmine (n = 40) or conventional treatment (n = 40). There was no significant difference in baseline parameters. The rate of decrease in IAP was significantly faster in the neostigmine group compared to the conventional group by 24 h (median with 25th–75th percentile: −18.7% [− 28.4 to − 4.7%] vs. − 5.4% [− 18.0% to 0], P = 0.017). This effect was more pronounced in patients with baseline IAP ≥ 15 mmHg (P = 0.018). Per-protocol analysis confirmed these results (P = 0.03). Stool volume was consistently higher in the neostigmine group during the 7-day observational period (all P < 0.05). Other secondary outcomes were not significantly different between neostigmine and conventional treatment groups.

Conclusion

Neostigmine reduced IAP and promoted defecation in patients with AP and IAH. These results warrant a larger, placebo-controlled, double-blind phase III trial.

Trial registration Clinical Trial No: NCT02543658 (registered August /27, 2015).

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

 

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

 

by Marije Smit, Bart Koopman, Willem Dieperink, Jan B. F. Hulscher, H. Sijbrand Hofker, Matijs van Meurs and Jan G. Zijlstra

 

Annals of Intensive Care volume 10, Article number: 130 (2020) Published: 01 October 2020

 

 

Background

Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study.

Results

Between March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03–1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08–5.96) and Apache IV score (OR 1.03, 95% CI 1.02–1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome.

Conclusions

The prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

by Adrian Regli, Paolo Pelosi and Manu L. N. G. Malbrain  

Annals of Intensive Care:  2019 9:52

The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world. One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay. IAH is associated with high morbidity and mortality. Although considerable progress has been made over the past decades, some important questions remain regarding the optimal ventilation management in patients with IAH. An important first step is to measure intra-abdominal pressure (IAP). If IAH (IAP > 12 mmHg) is present, medical therapies should be initiated to reduce IAP as small reductions in intra-abdominal volume can significantly reduce IAP and airway pressures. Protective lung ventilation with low tidal volumes in patients with respiratory failure and IAH is important. Abdominal-thoracic pressure transmission is around 50%. In patients with IAH, higher positive end-expiratory pressure (PEEP) levels are often required to avoid alveolar collapse but the optimal PEEP in these patients is still unknown. During recruitment manoeuvres, higher opening pressures may be required while closely monitoring oxygenation and the haemodynamic response. During lung-protective ventilation, whilst keeping driving pressures within safe limits, higher plateau pressures than normally considered might be acceptable. Monitoring of the respiratory function and adapting the ventilatory settings during anaesthesia and critical care are of great importance. This review will focus on how to deal with the respiratory derangements in critically ill patients with IAH.

Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients—A Prospective Multicenter Study (IROI Study)

Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients—A Prospective Multicenter Study (IROI Study)

by Reintam Blaser, Annika; Regli, Adrian; De Keulenaer, Bart; Kimball, Edward J.; Starkopf, Liis; Davis, Wendy A.; Greiffenstein, Patrick; Starkopf, Joel; the Incidence, Risk Factors, and Outcomes of Intra-Abdominal (IROI) Study Investigators  

Critical Care Medicine: April 2019 - Volume 47 - Issue 4 - p 535–542

Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population.

Design: Prospective observational study.

Setting: Fifteen ICUs worldwide.

Patients: Consecutive adult ICU patients with a bladder catheter. Interventions: None. Measurements and Main Results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28- and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were associated with the development of intra-abdominal hypertension during the first week in the ICU.

Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28- and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.

The gastro-renal effects of intra-abdominal hypertension: Implications for critical care nurses

The gastro-renal effects of intra-abdominal hypertension: Implications for critical care nurses

by Sherree Gray, Martin Christensen, Judy Craft  

Intensive and Critical Care Nursing

Intra-abdominal hypertension is classified as either primary or secondary – primary occurs due to intra-abdominal or retro-peritoneal pathophysiology, whereas secondary results in alterations in capillary fluid dynamics due to factors, such as massive fluid resuscitation and generalised inflammation. The renal and gastro-intestinal effects occur early in the progression of intra-abdominal hypertension, and may lead to poor patient outcomes if not identified. As a direct response to intra-abdominal hypertension, renal function is reduced with remarkable impairment from pressures of around 10 mmHg, oliguria developing at 15 mmHg and anuria developing at 30 mmHg.

The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice

The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice

Christensen M, Craft J
Intensive and Critical Care Nursing : Article in Press

Intra-abdominal hypertension can be classified as either primary or secondary. Primary intra-abdominal hypertension is often associated through trauma or diseases of the abdominopelvic region such as pancreatitis or abdominal surgery, while secondary intra-abdominal hypertension is the result of extra-abdominal causes such as sepsis or burns. The critically ill patient offers some challenges in monitoring in particular secondaryintra-abdominal hypertension because of the effects of fluid resuscitation, the use of inotropes and positive pressure ventilation. Recent work suggests that intensive care unit nurses are often unaware of the secondary effects of intra-abdominal pressure and therefore this is not monitored effectively. Therefore being aware of the cardio-respiratory effects may alert theintensive care nurse nurse to the development of intra-abdominal hypertension. The aim of this paper is to discuss the pathophysiology associated with the cardio-respiratory effects seen with intra-abdominal hypertension in the critically ill. In particular it will discuss how intra-abdominal hypertension can inadvertently be overlooked because of the low flow states that it produces which could be misconstrued as something else. It will also discuss how intra-abdominal hypertension impedes ventilation and respiratory mechanics which can often result in a non-cardiogenic pulmonary oedema. To close, the paper will offer some implications for critical care nursing practice.

Incidence and clinical effects of intra-abdominal hypertension in critically ill patients.

Vidal MG, Ruiz Weisser J, Gonzalez F, Toro MA, Loudet C, Balasini C, Canales H, Reina R, Estenssoro E.
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