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- •Contents
- •Contributors
- •Abbreviations
- •Foreword
- •Introduction
- •(Very) brief history of IAP
- •Further reading
- •Introduction
- •Background
- •The abdominal wall
- •The relation between IAP and IAV – compliance and elastance
- •Key points
- •Key points
- •Further reading
- •Measure IAP at the end of expiration
- •IAP is (usually) measured in the bladder
- •IAP can be measured through routes other than the bladder
- •IAP can be measured with fluid-filled or air-filled systems
- •IAP should be measured against a reference level
- •Instillation of fluid in the bladder is required
- •The temperature of the instillation fluid should be controlled
- •The patient’s body position is important
- •Supine versus semi-recumbent position
- •Prone position
- •Other positions
- •The effect of positive end expiratory pressure (PEEP) on IAP
- •Key points
- •Further reading
- •Introduction
- •Clinical estimation of IAP
- •Measurement of IAP is safe
- •Measurement of IAP is reproducible
- •Routes for IAP measurements
- •Transvesicular route
- •Transgastric route
- •Alternative routes
- •Modalities of IAP measurements
- •Available methods for IAP measurement
- •Intermittent IAP measurement
- •Transvesicular: Harahill method
- •Transvesicular: AbViserTM IAP Monitoring Kit
- •Transvesicular: Bard IAP® Monitoring Device
- •Transvesicular: Biometrix
- •Transvesicular: PreOx IAP Adapter
- •Transgastric: gastric tube or Collee method
- •Transgastric: gastric balloon method
- •Continuous IAP measurement
- •Continuous transvesicular IAP measurement
- •Continuous IAP monitoring – CiMON (Pulsion Medical Systems)
- •The IAP-Catheter and IAP-Monitor (Spiegelberg)
- •Key points
- •Further reading
- •Introduction
- •The pitfalls
- •Pitfalls related to the patient
- •Positioning of the patient
- •The awake patient
- •Intra-abdominal space-occupying lesions
- •Obesity
- •Children
- •Pitfalls related to the measurement technique
- •Zero reference level
- •Gastric route
- •Infusion volume
- •Infusion temperature
- •Frequency of IAP measurement
- •Pitfalls related to the interpretation of data
- •Key points
- •Further reading
- •What is abdominal compliance?
- •Why is abdominal compliance important?
- •Implications for clinical practice
- •How does decreased abdominal wall compliance lead to IAH?
- •Is this clinically important?
- •Can I and should I measure abdominal compliance in my patient?
- •How do I know when abdominal wall compliance is decreased?
- •How do I know when abdominal wall compliance is increased?
- •Key points
- •Further reading
- •Introduction
- •Measuring IAV
- •IAV in clinical practice
- •Is IAV relevant?
- •IAV and primary IAH
- •IAV and secondary IAH
- •Other ways in which IAV has an impact on IAH
- •Key points
- •Further reading
- •Introduction
- •Capillary dynamics
- •Capillary leak in the critically ill patient
- •IAP and the three hits model of shock
- •The ebb phase
- •The global increased permeability syndrome
- •Consequences of IAH and ACS in the patient with severe acute pancreatitis
- •When it starts to get better (day 3)
- •Key points
- •Further reading
- •Introduction
- •Why and when do patients with severe acute pancreatitis develop IAH and ACS?
- •Diagnosis of IAH and ACS in the patient with severe acute pancreatitis
- •Prevention of IAH and ACS in the patient with severe acute pancreatitis
- •Treatment of IAH and ACS in the patient with severe acute pancreatitis
- •Surgery
- •Feeding
- •When can the clinician stop considering IAH in patients with severe acute pancreatitis?
- •Key points
- •Further reading
- •Introduction
- •IAP in children
- •Normal values of IAP in children
- •Measurement of IAP in children.
- •Outcomes of IAP in children
- •IAH and ACS in children
- •Diagnosis of IAH and ACS in children
- •Management of IAH and ACS in children
- •Key points
- •Further reading
- •Introduction
- •Types of ACS in trauma patients
- •Incidence
- •The ‘bloody’ vicious circle and IAH
- •Conservative management of the patient with abdominal trauma
- •IAH in the patient with an open abdomen
- •Key points
- •Further reading
- •Introduction
- •Incidence
- •Consequences of IAH in the patient with severe burns
- •Monitoring IAP in the burn patient
- •IAH prevention in the burn patient
- •Urine output as an indicator during resuscitation of the burn patient
- •Treatment of IAH in the burn patient
- •Key points
- •Further reading
- •Introduction
- •Normal values of IAP in obese patients
- •IAP and chronic morbidity in the obese patient
- •Systemic hypertension
- •Pseudotumour cerebri
- •Respiratory morbidity
- •Incisional hernia
- •Key points
- •Further reading
- •Introduction
- •Pregnancy and IAP
- •Peritoneal dialysis and IAP
- •IAP during iatrogenic pneumoperitoneum
- •IAP in the haematological patient
- •Any other conditions leading to IAP?
- •Gastroenterology
- •Respiratory
- •Neurology
- •Cardiology
- •Gynaecology
- •Reconstructive surgery
- •Orthopaedics
- •Miscellaneous
- •Key points
- •Further reading
- •Introduction
- •Pathophysiology
- •Overall cardiovascular effects of IAH
- •IAH and preload
- •IAH and contractility
- •IAH and afterload
- •Implications for clinical practice
- •Filling pressures are inaccurate with IAH
- •What about volumetric monitoring?
- •Abdominal perfusion pressure (APP)
- •IAP and responsiveness to fluid
- •Key points
- •Further reading
- •Introduction
- •IAH and acute lung injury
- •IAH and lung distension
- •IAH and pulmonary oedema
- •IAP and mechanical ventilation
- •IAP and pulmonary hypertension
- •Key points
- •Further reading
- •Introduction
- •Incidence
- •Critical IAP in relation to renal function
- •The impact of IAH-induced kidney failure
- •Implications for clinical management
- •Diagnosis of AKI in patients with IAH?
- •Prevention of IAH-induced kidney injury?
- •How do I treat the patient with IAH-induced AKI?
- •Key points
- •Further reading
- •Introduction
- •How does IAH lead to intracranial hypertension?
- •Importance of the impact of IAH on ICP
- •Conditions associated with increased IAP and ICP
- •Implications for clinical management
- •Prevention of IAH-induced raised ICP
- •Treatment of IAH when ICP is raised
- •Key points
- •Further reading
- •The liver and IAH
- •Gastrointestinal function and IAH
- •The abdominal wall and IAH
- •Endocrine function and IAH
- •Key points
- •Further reading
- •Introduction
- •Multiple organ dysfunction syndrome
- •IAH as a marker of gastrointestinal dysfunction
- •Implications for clinical practice
- •Key points
- •Further reading
- •Introduction
- •Abdominal compartment syndrome
- •Other compartment syndromes
- •Hepatic compartment syndrome
- •Renal compartment syndrome
- •Pelvic compartment syndrome
- •Cardiac compartment syndrome
- •Intracranial compartment syndrome
- •Intraorbital compartment syndrome
- •Limbs or extremity compartment syndrome
- •Polycompartment syndrome
- •Key points
- •Further reading
- •Decreased abdominal wall compliance leads to IAH
- •Measuring abdominal compliance
- •Preventing decreased C-abd
- •Increasing abdominal wall compliance
- •Key points
- •Further reading
- •How do intraluminal contents lead to IAH?
- •Ileus and IAH
- •Enteral feed
- •Evacuation of intraluminal content
- •Surgical intervention
- •Key points
- •Further reading
- •Introduction
- •What are the causes of abdominal fluid collections leading to IAH?
- •What about more factors leading to IAH or ACS?
- •Implications for clinical management
- •Do all fluid collections require drainage?
- •How to drain abdominal fluid collections safely?
- •Which catheter should be used for draining fluid collections leading to IAH?
- •When is PCD to be avoided?
- •When does the patient need a (decompressive) laparotomy?
- •Key points
- •Further reading
- •Introduction
- •How does systemic inflammation lead to (secondary) IAH?
- •Incidence
- •Consequences of secondary IAH
- •Implications for clinical management
- •How to prevent development of secondary IAH?
- •What are the possible interventions for capillary leak syndrome?
- •How is capillary leak prevented or diminished?
- •How are fluids used in the patient at risk for IAH?
- •How is volume status and fluid responsiveness assessed in patients with IAH?
- •What fluids to use?
- •How is fluid overload associated with secondary IAH treated?
- •Key points
- •Further reading
- •Introduction
- •Octreotide in IAH
- •CNAP devices
- •Traditional Chinese medicine
- •Melatonin treatment
- •Nutrition
- •Key points
- •Further reading
- •Introduction
- •Can abdominal decompression treat ACS?
- •Is surgical decompression safe?
- •Surgery is for all patients
- •What surgical methods can be applied?
- •Should abdominal decompression be the only cure for ACS?
- •Implications for clinical management
- •When should surgical treatment be considered?
- •Can abdominal decompression be performed in the ICU?
- •What are the pitfalls when decompressing the abdomen in ACS?
- •Is decompression an option when only IAH is present?
- •Does every patient require TAC after decompressive laparotomy?
- •Key points
- •Further reading
- •Introduction
- •Characteristics of an ideal TAC
- •Negative pressure therapy measures
- •Implications for clinical management
- •What TAC technique is to be preferred?
- •Where to change the TAC
- •When to change the TAC
- •When to remove the TAC
- •Temporary abdominal closure techniques
- •Skin closure-only TAC
- •Synthetic cover-only TAC
- •Negative pressure TAC
- •Fascial approximation techniques
- •Key points
- •Further reading
- •Natural history of IAH shows that short-lived IAH can be tolerated by some patients
- •Continuous, hassle-free IAP measurement makes recognition of the problem easy
- •Prevention is better than therapy
- •Medical management is the gold standard for IAH
- •Decompressive laparotomy will no longer be a therapy for ACS
- •Open abdomen therapy is used selectively in the high-risk patient and for the shortest time possible
- •Epidemiology
- •Index

Index 235
afterload 134
ascites 189–190
awake patients, IAP
measurement 53
®
Bard IAP
monitoring device
42–43
bladder, IAP measurement see
trans-vesicular IAP
measurement
blood, intra-abdominal 189
burns 112–116, 214
capillary dynamics 76–79
capillary leak syndrome 76–88,
194–202
critically ill patient 79–86
prevention/interventions
196–201
cardiac compartment syndrome
173–174
cardiac output 131–132, 138, 147
cardiology patients 126
cardiovascular effects of IAH
131–140
central nervous system effects of
IAH 153–157
central venous pressure
measurements 137
chest wall mechanics 141, 143
children 100–105
IAH and ACS 102–104
IAP measurement 54, 100–102
normal IAP values 100
Chinese medicine, traditional
207–208
CiMON IAP monitoring
device 49
Collee method, IAP measurement
44–45
colloids, fluid resuscitation
–198, 200–201
197
compliance
abdominal wall see abdominal
wall compliance
respiratory system 143–144, 145
ventricular 135–136
continuous negative abdominal
pressure (CNAP) devices
205, 207
contractility, myocardial 134
critically ill patients
capillary leak 79–86
IAH 150, 195–196
IAP measurement 55
nutrition 209–210
Da Cheng Qi Decoction
207–208
decompressive laparotomy see
laparotomy, decompressive
definitions 14–23
diuretic therapy 150,
183–184, 202
Dynamic retention sutures 224
elastance, abdominal 9–11
Emerson, Haven 4
endocrine function 162
enteral nutrition 98, 166, 167,
186, 209
escharotomy 116, 214

236 Index
extravascular lung water (EVLW)
83, 84
extremity compartment
syndrome 175–176
fascial approximation techniques
224
feeding see nutrition
filling pressures, cardiac 135–137
filtration gradient (FG) 17
fluid balance 194–202
fluid collections, abdominal see
abdominal fluid collections
fluid compartments, intra-
abdominal 76
fluid overload 84, 87
abdominal compliance and 183
treatment 183–184, 201–202
fluid physics, basics 6–9
fluid resuscitation/management
abdominal perfusion pressure
as endpoint 138
acute kidney injury 150–151
assessing responsiveness
138–140, 199–200
burns 112, 115
capillary leak and 76–88,
197–198, 199
choice of fluids 200–201
intracranial hypertension 156
Foleymanometer
gastric balloon method, IAP
measurement 45–46
gastric tube method, IAP
measurement 44–45
38–39, 56
™
gastro-oesophageal
reflux 120
gastroenterology patients 125
gastrointestinal dysfunction
(GID) 164–165
definition 167
IAH as marker 166–167
gastrointestinal failure (GIF)
164–169
gastrointestinal function
definition 167
effects of IAH 159–161
gastrointestinal intraluminal
contents 185–187
evacuation 186–187
role in IAH 185–186
Glauber’s salt 207–208
global increased permeability
syndrome (GIPS) 83–85
gynaecological patients 126
haematological patients 124
Harahill method, IAP
measurement 39–41
hepatic compartment syndrome
171–172
hepatic effects of IAH 159, 160
hypertension, systemic 119
IAH see intra-abdominal
hypertension
intra-abdominal
IAP see
pressure
IAP-Catheter and IAP-Monitor
(Spiegelberg) 49–50
IAV see intra-abdominal volume

Index 237
ileus 185–186
inferior vena cava pressure 37
inflammation, systemic 79–80,
194–195
intra-abdominal hypertension
(IAH)
definition 20
future prospects 229–233
grades 20
primary see primary intra-
abdominal hypertension
risk factors 62, 72, 89
secondary see secondary
intra-abdominal
hypertension
intra-abdominal pressure (IAP)
3–13
children 100
definition 15–16
effect of PEEP 31–32, 145
end-expiratory (IAPee) 25–26
end-inspiratory (IAPei)/end-
expiratory (IAPee) difference
(ΔIAP) 66–67, 182
fluid physics 6–9
historical background 3–6
normal 19
obesity 118–119
relationship with IAV 5–6,
, 59
9–11
intra-abdominal pressure (IAP)
measurement 25–33,
230–231
bladder route see trans-vesicular
IAP measurement
burns 114
children 54, 100–102
clinical estimation 34
continuous 37–38, 47–50
direct vs indirect 35–36
fluid-filled or air-filled
systems 27
frequency 55
gastric route see trans-gastric
IAP measurement
intermittent 38–46
pancreatitis 95
patient positioning 30–31, 35,
52–53
pitfalls 52–56
reference level 17–19, 28, 54
reference standard 19
reproducibility 35
routes 25–27, 35–37
safety 35
techniques 34–51
–19
units 17
intra-abdominal space occupying
lesions 53
intra-abdominal volume (IAV)
69–75
in clinical practice 71–75
measurement 69–71
relationship with IAP 5–6,
9–11, 59
risk factors for increased 72
intracranial compartment
syndrome 174
intracranial hypertension
153–157
idiopathic see pseudotumour
cerebri

238 Index
intraluminal contents see
gastrointestinal intraluminal
contents
intraorbital compartment
syndrome 174–175
intrathoracic pressure, increased
131, 174
laparoscopy 124, 155
laparotomy, decompressive 214,
232
abdominal fluid collections
192–193
burns 116
pancreatitis 97
temporary abdominal closure
(TAC) 217, 219–224
see also open abdomen;
surgical decompression
limb compartment syndrome
175–176
liver function 159, 160
lung distension 143–144
medical management 231–232
see also treatment
melatonin 208
multiple organ dysfunction
syndrome (MODS) 161,
164–166
nasogastric aspiration 186, 187
negative extra-abdominal
pressure (NEXAP) 205, 207
negative pressure therapy 205,
219–220, 223
neurological patients 126
nutrition 166, 167, 209–210
pancreatitis 98
see also enteral nutrition
118–121
obesity
chronic morbidity and IAP
119–120, 155
IAP measurement 53
normal IAP values 118–119
octreotide 204–205
oedema
abdominal wall and viscera 60,
62–63, 74, 183
capillary leak syndrome 81, 84,
194–195
oliguria 17, 149–150, 172
open abdomen 183, 219–224,
232–233
burns 116
nutrition during 209
trauma 109–110
see also laparotomy,
decompressive
orthopaedic patients 126
pancreatitis 93–99
Pascal’s law 7
PEEP (positive end expiratory
pressure) 31–32, 145
pelvic compartment
syndrome 173
percutaneous drainage (PCD),
abdominal fluid collections
191–192
peritoneal dialysis 123, 151

Index 239
pneumoperitoneum, iatrogenic
124
polycompartment syndromes 84,
176
positioning, patient
IAP measurement 30–31, 35,
52–53
mechanical ventilation
145–146
positive end expiratory pressure
(PEEP) 31–32, 145
pregnancy 122–123
preload 133
PreOx Intra-abdominal Pressure
Adapter 43–44
primary intra-abdominal
hypertension 21
childhood risk factors 104
increased IAV 71–73
trauma 107, 108
prostheses, temporary abdominal
closure 223
pseudotumour cerebri 119, 155,
205
pulmonary effects of IAH
141–146
pulmonary hypertension 146
pulmonary oedema 144–145
pulse pressure variation (PPV)
138–139, 200
reconstructive surgery 126
renal compartment syndrome
172–173
renal function, impaired 84,
147–151, 202
renal replacement therapy (RRT)
150–151, 184, 202
Renasys abdominal closure
system 223
research needs 229–230, 233
respiratory effects of IAH
141–146
respiratory morbidity, obesity
119–120
respiratory patients 125
secondary intra-abdominal
hypertension 21–22
capillary leak and fluid
resuscitation 81–82, 84–85,
194–202
childhood risk factors 104
decreased abdominal
compliance 62–63
increased IAV 74
prevention 196–201
trauma 107, 108
shock, three hits model 82–86
skin closure-only temporary
abdominal closure 222
stomach, IAP measurement see
trans-gastric IAP
measurement
stroke volume variation (SVV)
138–139, 200
subcutaneous linea alba
fasciotomy (SLAF) 97,
109, 214
supine hypotension syndrome 122
surgical decompression 212–217,
232

240 Index
surgical decompression (cont.)
burns 115–116, 214
children 104
intracranial hypertension
154–155
pancreatitis 96–98
trauma 109–110
see also laparotomy,
decompressive
systemic inflammatory response
syndrome 194–195
temporary abdominal closure
(TAC) 217, 219–224
three hit model of shock 82–86
traditional Chinese medicine
207–208
trans-gastric IAP measurement 37
continuous methods 49–50
intermittent methods 44–46
pitfalls 54
trans-vesicular IAP measurement
25–27, 36
continuous 47–49
instillation volume 29–30, 55
intermittent methods 38–44
reference level 28
temperature of instillation fluid
30, 55
trauma 106–110
treatment 231–233
correction of capillary leak and
fluid balance 194–202
evacuation of abdominal fluid
collections 189–193
evacuation of intraluminal
contents 185–187
improving abdominal
compliance 181–184
specific 204–210
surgical see surgical
decompression
Uno-Meter Abdo-Pressure
38–39
urine output, burns 115
vacuum assisted closure 118
venous return 133, 139–140
ventilation, mechanical
145–146
volume status, assessing 199–200
volumetric monitoring 137,
199–200
™
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