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Latest news on abdominal pressure monitoring

Latest news on abdominal pressure monitoring. Jan J. De Waele MD PhD Surgical ICU Ghent University Hospital Ghent, Belgium. IAP monitoring??. Introduction. Fluid (over)load important contributor to IAH IAH and ACS identified as causes of organ dysfunction in critical care

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Latest news on abdominal pressure monitoring

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  1. Latest news on abdominal pressure monitoring Jan J. De Waele MD PhD Surgical ICU Ghent University Hospital Ghent, Belgium.

  2. IAP monitoring??

  3. Introduction Fluid (over)load important contributor to IAH IAH and ACS identified as causes of organ dysfunction in critical care IAP monitoring essential • Sole diagnostic tool

  4. Monitor IAP • Low index of suspicion • Prevent IAH • Operating theatre • Judicious fluid resuscitation • Open abdomen treatment • Surgical management • When IAP>25mmHg • Fulminant deterioration IAH management in the ICU • Medical management • IAP reducing strategies • Incorporate IAH in patient management

  5. IAP measurement

  6. IAP measurement basics Supine position No muscle contractions Only 25mL or less Transvesicular approach

  7. Femoral vein pressure? FVP cannot be used as a surrogate measure of IAP unless IAP is above 20 mmHg. De Keulenaer BL, Intensive Care Med 2011

  8. What is normal IAP? Normal IAP 5-7mmHg Effect of body weight?

  9. IAP and HOB positioning Most patients are nursed in 30-45°HOB Effect of positioning?

  10. IAP and prone positioning Zero reference level? Abdominal support

  11. IAP and PEEP

  12. Pitfalls Zero reference level Inter-observer differences Mark the IAP reference level on the patient!

  13. Pitfalls Mass lesions in the pelvis – external compression

  14. The abdomen as a hydraulic system Is the abdomen a liquid filled container?

  15. IAP determinants Gravity Wall tension Solid organs, fluid and gas Relevant Dependent on volume and density Pascal’s law • Abdominal wall + diaphragm • Relevant if compliance is low

  16. IAP determinants Gravity Wall tension

  17. IAP High compliance

  18. IAP Low compliance

  19. So what?

  20. Explains organ dysfunction dynamics in IAH First symptoms • Kidney • Hemodynamics Later • Respiratory

  21. Explains effect of positioning Effect of HOB elevation? IAP 16

  22. Explains effect of positioning Effect of HOB elevation?

  23. Predicts effect of therapy Role of abdominal decompression • = increase in compliance of abdominal wall

  24. Conclusion IAP measurement established • IAP determinants • Pitfalls IAP measurement is simple Effect of ICU interventions on IAP minimal • Be careful when proning New paradigms for *unexplained* observations and therapy

  25. Thank you for your attention Email: Jan.DeWaele@UGent.be Twitter: @JanDeWaeleMD

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