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

Too LATE

Get Real