Abdominal pressure in the critically ill

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Abstract
Gut dysfunction resulting in increased gut permeability and subsequent bacterial translocation may play an important role in the development of multiple organ system failure in the critically ill within this concept. Intra-abdominal pressure is an important parameter and prognostic indicator of the patient’s underlying physiologic status. Initially thought to affect primarily trauma and surgical patients, intra-abdominal hypertension and the abdominal compartment syndrome have recently also been identified in about 20% of critically ill medical patients. Even slightly increased intra-abdominal pressure, as low as 10 mm Hg, has deleterious effects on end-organ function, impairing neurologic, cardiac, respiratory, gastrointestinal, hepatic, and renal homeostasis. Rapid restoration of volume status and abdominal decompression is essential to preserve organ function, although massive fluid overload may trigger a vicious cycle which by itself may cause intra-abdominal hypertension. The traditional filling pressures are unreliable indices of preload, necessitating the use of new markers, such as right ventricular end diastolic volume index or intrathoracic blood volume index to assess volume status and resuscitate these patients correctly. New techniques, such as intravesical or intragastric pressure monitoring combined with intramucosal pH, together with an high clinical index of suspicion, help the intensivist make a correct diagnosis, adjust treatment, and decide on early decompressive laparotomy with temporary abdominal closure.