Problematic of intra-abdominal pressure measurement

Intra-abdominal hypertension (intra-abdominal pressure, IAP > 12 mmHg) is observed in more than 30% of critically ill patients and is of major prognostic relevance. Unfortunately, clinical examination alone does not allow the IAP to be estimated with sufficient accuracy. Consequently, IAP monitoring should be considered if risk factors for intra-abdominal hypertension are present in order to enable early therapeutic intervention. A technically simple estimation of IAP is possible by intravesical pressure measurements. Alternatively, intragastric pressure can be measured continuously and IAP changes can be detected rapidly. In addition the development of IAP values over time can be appreciated more comprehensively compared to single snapshot-like measurements. The goal of IAP monitoring is not to keep the IAP below a certain threshold, but rather to establish a sufficient abdominal perfusion pressure [APP=mean arterial pressure (MAP)-IAP] of 50-60 mmHg. However, no data have yet been provided showing that the routine use of IAP monitoring and APP targeted therapy is able to improve the prognosis of critically ill patients.