Patients with an IAP >25mmHg need abdominal
decompression
Michael Sugrue
IAP > 25mmHgOccurs in 8% of ICU population
Sugrue Arch Surg 1999
Prevalence of IAP >25mmHg
0
10
20
30
40
50
60
70
IAP< 18 IAP18-25 IAP >25
Sugrue et al Arch Surg 1999
Is IAP the Key?
ROC curve analysis of predictors of survival from IAH
Sensitivity
1- Specificity
0 1.0
1.0
Cheatham et al J Trauma 00
Heinricius Bern 1890
Ueber den einfluss der bauchfulling auf circulation und respiration Z Biol
Abdominal Pressure Volume Curve
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5 6
IAP
mmHg
Litres Sugrue et al Inten Care Med 94
Paediatric Surgeons
time
0h 6h 12h 18h 24h
100
200
300
400 15mmHg 30mmHg control
*
ANOVA p< 0.05 *: T-test p<0.05 *: T-test p<0.05
Alk Phos and IAPAlk Phos and IAP
Histological changes after 4 hrsHistological changes after 4 hrs
Liver
Control 30mmHg
Study of compartment pressure on cardiac output
Kitano JAP 1999
0
200
400
600
800
1000
1200
base 8 15 30 40 50
IAP
C.O
.
Evidence Authors n Improved Survived
organ function %
Burrows 4 100 75Ertel 17 100 59Fietsam 4 100 25Ivatury 23 71 65Kron 11 100 71Kopelman 6 83 17Morris 16 80 40Sugrue49 20 61
Evidence Authors n Improved Survived
organ function %
Burrows 4 100 75Ertel 17 100 59Fietsam 4 100 25Ivatury 23 71 65Kron 11 100 71Kopelman 6 83 17Morris 16 80 40Sugrue49 20 61
When IAP > 25mmHg
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