Intra-abdominal Hypertension and the Open Abdomen: Nursing Guidelines From the Abdominal Compartment Society.

Intra-abdominal hypertension has been identified as an independent risk factor for death in critically ill patients. Known risk factors for intra-abdominal hypertension indicate that intra-abdominal pressures should be measured and monitored. The Abdominal Compartment Society has identified medical and surgical interventions to relieve intra-abdominal hypertension or to manage the open abdomen if abdominal compartment syndrome occurs. The purpose of this article is to describe assessments and interventions for managing intra-abdominal hypertension and open abdomen that are within the scope of practice for direct-care nurses. These guidelines provide direction to critical care nurses caring for these patients.

Intra-abdominal hypertension and abdominal compartment syndrome in pediatrics. A review.

PURPOSE: To consolidate pediatric intensivists' understanding of the pathophysiology, definition, incidence, monitoring, and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); and to highlight the characteristics related to the pediatric population. METHODS: This is a narrative review article that utilized a systematic search of the medical literature published in the English language between January 1990 and august 2016. Studies were identified by conducting a comprehensive search of Pub Med databases. Search terms included "intra-abdominal hypertension and child", "intra-abdominal hypertension and pediatrics", "abdominal compartment syndrome and child", and "abdominal compartment syndrome and pediatrics". RESULTS: Intra-abdominal hypertension and ACS are associated with a number of pathophysiological disturbances and increased morbidity and mortality. These conditions have been well described in critically ill adults. In children, the IAH and the ACS have a reported incidence of 13% and 0.6 to 10% respectively; they carry similar prognostic impact but are still under-diagnosed and under-recognized by pediatric health care providers. CONCLUSIONS: Intra-abdominal hypertension and ACS are conditions that are regularly encountered in critically ill children. They are associated with an increased morbidity and mortality. Early recognition, prevention and timely management of this critical condition are necessary to improve its outcome.

Semi-recumbent position and body mass percentiles: effects on intra-abdominal pressure measurements in critically ill children.

PURPOSE: Patient position and body mass index (BMI) affect intra-abdominal pressure (IAP) measured by the intra-vesical method in adults. We sought to determine effects of patient position and BMI on IAP in children because accurate measurement and interpretation of IAP are important for patient management. METHODS: Seventy-seven mechanically ventilated children (<18 years) admitted to a PICU were prospectively studied. IAP was taken with the head of the bed at 0 degrees and 30 degrees every 6 h over a 24-h period. Statistical methods included descriptives, univariate statistics to identify potential confounding variables and multivariable analysis to assess the impact of position on IAP after adjusting for the significant covariates. RESULTS: Seventy-seven patients had 290-paired IAP measurements. Mean IAP at 30 degrees was 10.6 +/- 4.0 compared to 8.4 +/- 4.0 at 0 degrees , which was significantly higher (p = 0.026) even after adjusting for age, gender and length. There was no correlation between IAP and actual BMI or BMI percentiles. CONCLUSION: Patient position should be considered when interpreting IAP. BMI did not influence IAP measurements in children.