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List of contributors ix
Children (Section 3)
J . CHIAKA EJIKE AND DONALD C. MOORES Department of
Pediatric Critical Care Medicine, Loma Linda University, CA,
USA
Burns (Section 3)
JUN ODA Department of Emergency and Critical Care Medicine,
Tokyo Medical University Hospital, Tokyo, Japan
Obesity (Section 3)
HADLEY HERBERT, THERESE DUANE AND
RAO IVATURY
Department of Surgery, Virginia Commonwealth
University, Richmond, Virginia , USA
Pancreatitis (Section 3)
ARI LEPPANIEMI Department of Surgery, Meilahti hospital,
University of Helsinki, Finland
Renal System (Section 4)
ERIC HOSTE Department of Intensive Care, University Hospital,
Ghent, Belgium
How to Define Gastrointestinal Failure (Section 4)
ANNIKA REINTAM BLASER Department of Intensive Care, Tartu
University Hospital, Tartu, Estonia
ABBREVIATIONS
ACCP American College of Chest Physicians
ACS abdominal compartment syndrome
AKI acute kidney injury
APP abdominal perfusion pressure
BMI body mass index
C-abd compliance abdominal wall
CAPD chronic ambulatory peritoneal dialysis
CNAP continuous negative abdominal pressure
CVP central venous pressure
E-abd elastance abdominal wall
EVLW extravascular lung water
FG filtration gradient
GEDV global end-diastolic volume
GFP glomerular filtration pressure
GID gastrointestinal dysfunction
GIF gastrointestinal failure
GIPS global increased permeability syndrome
IAH intra-abdominal hypertension
IAP intra-abdominal pressure
IAPee intra-abdominal pressure at the end of
expiration
List of abbreviations xi
IAPei intra-abdominal pressure at the end of
inspiration
IAV intra-abdominal volume
ICP intracranial pressure
ICU Intensive Care Unit
IGP intragastric pressure
IVP intravesicular pressure
LVEDV left ventricular end-diastolic volume
MAP mean arterial pressure
MODS multiple organ dysfunction syndrome
MOF multi-organ failure
NEXAP negative extra-abdominal pressure
OCT octreotide
PAOP pulmonary arterial occlusion pressure
PCD percutaneous drainage
PEEP positive end expiratory pressure
PPV pulse pressure variation
PTP proximal tubular pressure
P/V pressure–volume
Pv0 baseline pressure, measured without addition
of volume
RRT renal replacement therapy
SCCM Society of Critical Care Medicine
SIRS systemic inflammatory response syndrome
SOFA sequential organ failure assessment
SVV stroke volume variation
TAC temporary abdominal closure
WSACS World Society of the Abdominal Compartment
Syndrome
FOREWORD
It is a pleasure to write the preface for this book in the
Core Critical Care series, entitled Intra-abdominal
Hypertension.
This book brings together in one volume all the clinician
needs to know about the physiology of intra-abdominal
pressure (IAP) in health and in disease. This knowledge is
crucial for the successful treatment of the critically ill, whether
medical or surgical, young or old. Intra-abdominal
hypertension (IAH) and the more sinister sequel, abdominal
compartment syndrome (ACS), have been known for at least
two centuries. We now understand that they are frequent
causes of increased morbidity and mortality in many of our ICU
patients. More importantly, we now know that they are
correctable causes, easily diagnosed and effectively treated,
only if the clinician is aware of the condition and pursues its
recognition.
Drs Malbrain and De Waele, as past President and
President-elect, respectively, of the World Society of Abdominal
Compartment Syndrome (WSACS), are leaders in this field. The
Society is a multispecialty, multinational and multitalented
association of individuals sharing a common goal – fostering
education and promoting awareness of IAH and ACS.
xiv Foreword
Both authors are renowned investigators and educators. In
this book they have assembled what is truly important. The
book provides readers with an easily accessible and readily
digestible fund of knowledge that will, undoubtedly, translate
into many saved lives. It is a useful bedside reference for all
physicians, nurses and other members of the multidisciplinary
team working in the ICU.
It is a personal privilege to be associated with the WSACS and
this important work. I hope the reader studies it well and often,
for he or she may savour the benefits of gained knowledge in
grateful smiles from patients and their families.
Rao R. Ivatury MD, FACS
President
WSACS
Understanding intra-abdominal
hypertension: what to worry about?
Section 1
Chapter 1
What is intra-abdominal pressure?
Introduction
Awareness of the physiological importance of intra-abdominal
pressure (IAP) has increased over the past 20 years.
It is important to understand the structure of the
abdominal wall and its compliance (C-abd) to comprehend
IAP fully, and how it relates to the content of the abdomen and
thus intra-abdominal volume (IAV). IAP is a pressure that
obeys the general laws of physics. It is the steady-state
pressure present within the abdominal cavity.
IAP changes during respiration, increasing during
inspiration and decreasing during expiration.
The basics of IAP history, abdominal anatomy and fluid
physics are the main subjects of this chapter.
(Very) brief history of IAP
The timeline of IAP science is shown in Figure 1.1.
Poiseuille (1797–1869) was the first to measure pressures in
confined body regions with mathematical accuracy. How we
measure physiological pressures has evolved over the centuries,
with much emphasis placed on arterial blood pressure.
4 Section 1: Understanding IAH: what to worry about?
1863: Marey describes
physiology of IAP
1870: Bert describes
impact of IAP on respiration
1873: Wendt describes
Renal impact of IAP
1875: Oderbrecht reports
Bladder IAP measurement
1911: Emerson studies IAH
induced cardiorespiratory failure
1890: Heinricius describes
acute vs chronic IAH
1947: Bradley reports
Decreased GFR
1948: Gross introduces
staged abdominal repair
1951: Baggot suggests
use of open abdomen
1976: Richardson studies
cardiorespiratory impact of IAH
1984: Kron reports use of
bladder pressure as mortality
predictor
1989: Cullen reports
abdominal decompression
1989: Fietsam coins term ACS
2002: Sugrue organises
First World Congress on ACS
2004: Foundation of
World Society of Abdominal
Compartment Syndrome
www.wsacs.org
2000195019001850
2006: Publication of
WSACS Consensus Definitions
Figure 1.1
The Frenchman Etienne-Jules Marey (1830–1904) stated that
‘effects’ produced in the thorax by respiration are inverse to
those present in the abdomen. Paul Bert (1833–1886), another
Frenchman, measured pressures through tubes inserted in the
trachea and rectum while working in Claude Bernard’s
laboratory. He described elevation of IAP during inspiration,
explaining that this was caused by diaphragmatic descent.
Haven Emerson (1874–1957), a physician educated at
Harvard, published his epoch-making results of IAP
measurements in 1911. He developed an apparatus for direct
intraperitoneal pressure measurements and found the pressure
to be equal in different parts of the abdomen. Hence the
abdomen was considered primarily fluid in character, following
Pascal’s Law. He associated cardiovascular collapse with very
high IAPs and showed that drainage of ascitic fluid led to
cardiac recovery.
In 1946, it was demonstrated that the magnitude of pressure
at various levels in the abdomen is related to the height of the
hydrostatic column of abdominal contents above the point of
measurement. In other words, it was recognized that the