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CONSENSUS DEFINITIONS Manu MALBRAIN, MD

6-Dec-04. CONSENSUS DEFINITIONS Manu MALBRAIN, MD. Director Intensive Care Unit Ziekenhuis Netwerk Antwerpen Campus Stuivenberg B-2060 Antwerp BELGIUM. manu.malbrain@skynet.be. How much is the IAP in this patient with ascites ?. How much is the IAP after 5800mL paracenthesis ?.

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CONSENSUS DEFINITIONS Manu MALBRAIN, MD

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  1. 6-Dec-04 CONSENSUS DEFINITIONS Manu MALBRAIN, MD Director Intensive Care Unit Ziekenhuis Netwerk Antwerpen Campus Stuivenberg B-2060 Antwerp BELGIUM manu.malbrain@skynet.be

  2. How much is the IAP in this patient with ascites ? How much is the IAP after 5800mL paracenthesis ? 10-15-20-25 ? 10-15-20-25 ?

  3. In Medicine, as in real life, things are seldom what they seem…

  4. How much is the IAP in this patient with ascites ? How much is the IAP after 5800mL paracenthesis ? BMI Chest wall compliance Abdominal compliance Body position Fluid balance PEEP ventilation Medication … 10-15-20-25 ? 10-15-20-25 ?

  5. WSACS: World Society on Abdominal Compartment Syndrome, visit www.wsacs.org WCACS: Second World Congress on Abdominal Compartment Syndrome, Noosa, Australia, dec 6-9 2004, visit www.conventionhouse.com/ACS2004 WHAT IS IAP? Consensus Definitions

  6. WSACS: World Society on Abdominal Compartment Syndrome, visit www.wsacs.org WCACS: Second World Congress on Abdominal Compartment Syndrome, Noosa, Australia, dec 6-9 2004, visit www.conventionhouse.com/ACS2004 Definition 1: IAP The intraabdominal pressure is the pressure concealed within the abdominal cavity The intraabdominal pressure varies with respiration

  7. Definitions of IAH or ACS stand or fall with the accuracy and reproducibility of the IAP measurement method used !

  8. IAP - IBP Low Normal High IAP = 3±7 mmHg IAP = 8±7 mmHg (IAP-IBP)/2 15 Criteria for Validation 10 5 0 -5 -10 -15

  9. WSACS: World Society on Abdominal Compartment Syndrome, visit www.wsacs.org WCACS: Second World Congress on Abdominal Compartment Syndrome, Noosa, Australia, dec 6-9 2004, visit www.conventionhouse.com/ACS2004 Definition 3: IAH IAH is defined by an IAP value of > 12 mmHg which is recorded by minimum of three standardized pressure measurements that are conducted 4-6 hours apart

  10. WSACS: World Society on Abdominal Compartment Syndrome, visit www.wsacs.org WCACS: Second World Congress on Abdominal Compartment Syndrome, Noosa, Australia, dec 6-9 2004, visit www.conventionhouse.com/ACS2004 Definition 4: Grading Grade I. IAH: IAP between 12-15 mmHg Grade II. IAH: IAP between 16-20 mmHg Grade III. IAH: IAP between 21-25 mmHg Grade IV. IAH: IAP greater than 25 mmHg

  11. APP = 60 mmHg APP = 50 mmHg APP = 40 mmHg IAP = 25 mmHg IAP = 20 mmHg IAP = 15 mmHg Treshold Determination: AUROC

  12. “Grey-Zone” between IAH-ACS

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