From the Guidelines
Elevated intravesical pressure is indicative of abdominal compartment syndrome (ACS) when it exceeds 12 mmHg, as defined by the presence of intra-abdominal hypertension (IAH) and new organ dysfunction. This measurement is obtained through a urinary catheter connected to a pressure transducer, with the patient in a supine position and the transducer zeroed at the level of the mid-axillary line. The diagnosis of ACS requires both elevated intra-abdominal pressure and evidence of new organ dysfunction, such as decreased urine output, increased ventilatory pressures, or hemodynamic instability, as stated in the guidelines from the World Society of the Abdominal Compartment Syndrome 1.
Key Points to Consider
- The trans-bladder technique is recommended as the standard IAP measurement technique, as it is a reliable surrogate for direct measurement of intra-abdominal pressure 1.
- Protocolized monitoring and management of IAP are crucial in high-risk patients, including those with massive fluid resuscitation, abdominal trauma, or major abdominal surgery, to avoid sustained IAH and its consequences 1.
- Decompressive laparotomy is recommended in cases of overt ACS, as it is a life-saving intervention that can help alleviate the pressure and prevent further organ damage 1.
- Regular monitoring of bladder pressure is essential in high-risk patients to detect early signs of IAH and ACS, allowing for prompt intervention and improving outcomes.
Clinical Implications
The early detection and management of elevated intravesical pressure are critical in preventing the progression to ACS, which is a medical emergency requiring prompt decompression. By following the guidelines and recommendations from the World Society of the Abdominal Compartment Syndrome, clinicians can improve patient outcomes and reduce morbidity and mortality associated with ACS 1.
From the Research
Definition and Diagnosis of Abdominal Compartment Syndrome
- Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) exceeding 20 mm Hg, which causes end-organ damage due to impaired tissue perfusion 2.
- The gold standard for diagnosis is repeated assessment of the IAP measurements of bladder pressure 3.
- Elevated bladder pressure is also seen from compression due to increased abdominal pressure, and its measurement, via a Foley catheter, is a diagnostic hallmark 2.
Relationship between IntraVesical Pressure and Abdominal Compartment Syndrome
- Sustained intra-bladder pressures beyond 20 mm Hg with organ dysfunction are indicative of ACS requiring intervention 2, 3.
- Intra-abdominal hypertension is typically defined as abdominal pressure greater than or equal to 12 mm Hg, and ACS develops in most cases when IAP rises above 20 mmHg 4.
- Elevated intravesical pressure can be a sign of increased abdominal pressure, which can lead to ACS if left untreated 5.
Clinical Significance and Treatment
- ACS is characterized by a persistent pathologic increase in intra-abdominal pressure exceeding 20 mmHg with consecutive dysfunction of multiple organ systems 3.
- The therapy of choice for ACS is decompressive laparotomy, and surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction 3, 6.
- Close monitoring of organ function and intra-abdominal pressure allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP 6.