To this day, patients may have unrecognized IAH as awareness is still low. Moreover, one in twenty mixed ICU patients will develop overt abdominal compartment syndrome, a lethal syndrome with a mortality rate above 75% when left untreated. This review will focus on how to deal with the respiratory derangements in critically ill patients with IAH.Īround one in four to one in three patients present with IAH on admission to intensive care unit (ICU) while around one in two will develop IAH within the first week of ICU stay. Monitoring of the respiratory function and adapting the ventilatory settings during anaesthesia and critical care are of great importance. During lung-protective ventilation, whilst keeping driving pressures within safe limits, higher plateau pressures than normally considered might be acceptable. During recruitment manoeuvres, higher opening pressures may be required while closely monitoring oxygenation and the haemodynamic response. In patients with IAH, higher positive end-expiratory pressure (PEEP) levels are often required to avoid alveolar collapse but the optimal PEEP in these patients is still unknown. Abdominal-thoracic pressure transmission is around 50%. Protective lung ventilation with low tidal volumes in patients with respiratory failure and IAH is important. If IAH (IAP > 12 mmHg) is present, medical therapies should be initiated to reduce IAP as small reductions in intra-abdominal volume can significantly reduce IAP and airway pressures. An important first step is to measure intra-abdominal pressure (IAP). Although considerable progress has been made over the past decades, some important questions remain regarding the optimal ventilation management in patients with IAH. IAH is associated with high morbidity and mortality. One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay. The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world.
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