Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND! J.J. De Waele, I. De laet & M.L.N.G. Malbrain To cite this article: J.J. De Waele, I. De laet & M.L.N.G. Malbrain (2007) INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!, Acta Clinica Belgica, 62:sup1, 6-8, DOI: 10.1179/ acb.2007.62.s1.002 To link to this article: http://dx.doi.org/10.1179/acb.2007.62.s1.002
Published online: 30 May 2014.
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Date: 18 April 2016, At: 04:21
6
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!
Original article – OA 1
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND! Downloaded by [Orta Dogu Teknik Universitesi] at 04:21 18 April 2016
J.J. De Waele1, I. De laet2, M.L.N.G. Malbrain2
INTRODUCTION Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are relatively newly discovered problems in critically ill patients (1, 2), but in fact, they have been around since the early days of critical care medicine and even before. Many of us may well remember treating patients with tense, distended abdomens, after emergency abdominal surgery, or in patients suffering from diseases such as acute pancreatitis. Many patients who eviscerated in the intensive care unit (ICU) were sent back to the operating room for fascial closure, whereas these cases of spontaneous decompression should be seen as a natural defence mechanism and a sign that the physiology of the patient was compromised. All too often, the final common pathway was therapy resistant multiple organ dysfunc-
––––––––––––––– 1 Intensive Care Unit, Ghent University Hospital, Gent, Belgium; 2 Intensive Care Unit, Campus Stuivenberg, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium Address for correspondence: Jan J. De Waele, M.D. Intensive Care Unit 1K12-C Ghent University Hospital De Pintelaan 185 9000 Gent Belgium Tel: +32 9 240 27 75 Fax: +32 9 240 49 95 Email [email protected]
Acta Clinica Belgica, 2007; 62-Supplement 1
tion syndrome leading to exitus in the majority of these patients. So, why did we not think of IAH and ACS earlier? As you will read in the paper by Van Hee in this issue (3), the effects of IAH have been recognized for many years, but hardly got any attention from the physicians taking care of the most severely ill patients in the hospital. The first cases described in the era of modern critical care medicine date back to the early 1980s, when case series of patients dying from multiple organ dysfunction syndrome (MODS) after emergency surgical procedures were reported in the surgical literature (4, 5). The first descriptions of simple intraabdominal pressure (IAP) measurement techniques date from the same time period (6, 7). When looking back, the patients described in these early papers were pretty obvious cases of ACS, mostly after abdominal trauma or emergency abdominal surgery. This is where time stood still again. The majority of manuscripts that were published on the topic of IAH reiterated the classical face of ACS: the postoperative patient, hemodynamically unstable, oliguric and difficult to ventilate. The advent of laparoscopic surgery taught us that minor changes in IAP may also affect organ function, and that became the focus of intense research, especially in the second part of the 1990s. At the same time, more IAP measurement techniques were developed and became widely available (8). Finally the realization that minor elevations in IAP may also be relevant in the critically ill patient appeared (9, 10). All this renewed interest has resulted in an exponentially increasing number of publications on IAH and ACS and eventually in the foundation of the World Society for the Abdominal Compartment Syndrome (WSACS), a multidisciplinary organisation dedicated to foster
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!
education and research on ACS. The WSACS has organised two World Congresses to this day and has published consensus definitions and recommendations on IAH and ACS (11, 12). The members of WSACS have also published a number of articles and editorials urging critical care specialists to pay attention to this complex problem (13-21).
Downloaded by [Orta Dogu Teknik Universitesi] at 04:21 18 April 2016
ARE WE PAYING ATTENTION NOW? A number of surveys have demonstrated that the awareness of the problem is high among intensivists and surgeons, at least in the individuals who took the time to fill out these questionnaires (22). This awareness will undoubtedly not be present in all intensivists or (trauma) surgeons who may be confronted with ACS, so the initial enthusiasm for the results of these surveys may be unwarranted. Especially in smaller hospitals where physicians and nurses are less frequently confronted with the problem of IAH and ACS, or with patients at risk for ACS, the level of awareness may be low. In the paper by Kimball et al., considerable differences existed between surgeons, internists and paediatricians: up to a quarter of paediatric and medical intensivists were unaware of common procedures such as bladder pressure measurement (23). But these questionnaires also raised another question: is awareness enough to effectively manage a patient with ACS? A considerable lack of knowledge was demonstrated by Kimball et al. who reported that the majority of the respondents believed that an IAP of 20-27mmHg was needed before physiologic compromise could occur (23). Moreover, considerable differences exist regarding the management of patients with IAH and ACS among physicians who consider themselves to be aware of the problem. In a survey of British hospitals, there was no agreement on the frequency or indications for IAP measurement, or indications for decompressive laparotomy (24). Kimball demonstrated that depending on the background of the critical care physician, strategies such as diuretics, paracentesis or the use of decompressive laparotomy were graded differently for the treatment of ACS (23). These findings may not be surprising given the lack of measurement guidelines and guidelines related to the management of these patients, which remains problematic. Kirckpatrick et al. reported that none of the members of the Canadian Trauma Association had a policy regarding the management of open abdomens (25).
The attention deficit still present in some ICU’s or in some intensivists is probably even more prominent outside the ICU. IAH may occur in the postoperative patient, who is in the post anaesthesia care unit or the general ward, and it may cause or contribute to organ dysfunction. IAH may be present in surgical patients who undergo emergency surgery for gastrointestinal obstruction, or in patients with chronic liver disease or acute pancreatitis in the gastroenterology ward. Whereas most physicians consider IAH and ACS to be an ICU problem, efforts should be made to educate at least everybody who takes care of patients with acute gastrointestinal problems. Table 1 estimates the likelihood of different medical specialties being confronted with IAH and ACS.
SO, WHERE DO WE GO FROM HERE? The ‘paying attention’ message has not lost its importance and we have to continue to bring this message, especially towards non critical care or surgery specialists. But at the same time, we need to move beyond this first step and bring another message to those who are already paying attention. The effects of elevated IAP have been described extensively, and they are summarized in a number of manuscripts in this supplement of Acta Clinica Belgica. IAH affects cardiovascular, pulmonary, renal, gastrointestinal and neurological function, and there is an evident association between the occurrence of IAH and ACS and mortality. It is evident from epidemiological studies that IAH and ACS are frequent findings in the ICU, not only in surgical patients, but also in medical patients and in children. However, in spite of all this recently acquired knowledge and all the efforts made, there are still important issues to be resolved. For example, there are still many uncertainties regarding optimal IAP measurement (the influence of patient positioning, the optimal timing of
Table 1. Likelihood of being confronted with IAH, ACS or patients at risk for IAH/ACS Very frequently Frequently
Often Occasionally
• • • • •
Intensivist Surgeon (trauma, GI) Anesthesiologist Emergency physician Surgeon (transplant, oncology, general, pediatric) • Gastroenterologist • Surgeon (thoracic, orthopedic)
Acta Clinica Belgica, 2007; 62-Supplement 1
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INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!
Downloaded by [Orta Dogu Teknik Universitesi] at 04:21 18 April 2016
measurement, the value of continuous measurement, the importance of voluntary muscle activity in awake patients etc.), the temporal relationship between IAH and organ dysfunction is not clearly identified, a causal relationship between IAH and mortality has not been conclusively proven and many studies describing the relationship between IAH and organ dysfunction were conducted with outdated IAP measurement techniques and unreliable definitions for organ dysfunction. All these issues need to be studied soon, preferably before any attempts at treatment studies are undertaken.
CONCLUSION Insights in IAH and ACS are evolving rapidly. Paying attention is important, but it is only a first step towards the effective management of the patient with IAH and ACS. Understanding IAH is the next step, and treatment is the last one. Many questions remain to be solved regarding basic issues such as IAP measurement and the temporal relationship between IAH and organ dysfunction before we are really ready to tackle this complex syndrome. We should not try to run before we can walk.
REFERENCES 1. Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med. 1989; 17: 11821. 2. Schein M, Wittmann DH, Aprahamian CC, Condon RE. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. 1995; 180: 745-753. 3. Van Hee RH. Historical highlights in concept and treatment of abdominal compartment syndrome. Acta Clin Belg. 2007; 62: in press. 4. Richards WO, Scovill W, Shin B, Reed W. Acute renal failure associated with increased intra-abdominal pressure. 1983; 197: 183-7. 5. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. 1984; 199: 28-30. 6. Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. 1987; 15: 1140-2. 7. Iberti TJ, Lieber CE, Benjamin E. Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. 1989; 70: 47-50.
Acta Clinica Belgica, 2007; 62-Supplement 1
8. Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004; 30: 357-71. 9. Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005; 33: 315-22. 10. Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intraabdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004; 30: 822-9. 11. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006; 32: 1722-32. 12. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007; in press. 13. Balogh Z, De Waele JJ, Kirkpatrick A, Cheatham M, D’Amours S, Malbrain M. Intra-abdominal pressure measurement and abdominal compartment syndrome: The opinion of the World Society of the Abdominal Compartment Syndrome. Crit Care Med. 2007; 35: 677-8. 14. Malbrain ML. Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care. 2004; 10: 132-45. 15. Malbrain ML, Deeren D, De Potter TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care. 2005; 11: 156-71. 16. Ivatury RR. Abdominal compartment syndrome: a century later, isn’t it time to accept and promulgate? Crit Care Med. 2006; 34: 2494-5. 17. Ivatury RR, Sugerman HJ. Abdominal compartment syndrome: A century later, isn’t it time to pay attention? Crit Care Med. 2000; 28: 2137-8. 18. Sugrue M. Intra-abdominal pressure: time for clinical practice guidelines? Intensive Care Med. 2002; 28: 389-91. 19. Ball CG, Kirkpatrick AW. ‘Progression towards the minimum’: the importance of standardizing the priming volume during the indirect measurement of intra-abdominal pressures. Crit Care. 2006; 10: 153. 20. Malbrain M, Pelosi P. Open up and keep the lymphatics open: they are the hydraulics of the body! Crit Care Med. 2006; 34: 2860-2. 21. Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care. 2005; 11: 333-8. 22. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, De Waele J, Ivatury R. Abdominal compartment syndrome: it’s time to pay attention! Intensive Care Med. 2006; 32: 1912-4. 23. Kimball EJ, Rollins MD, Mone MC, et al. Survey of intensive care physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome. Crit Care Med. 2006; 34: 2340-8. 24. Ravishankar N, Hunter J. Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study. Br J Anaesth. 2005; 94: 763-6. 25. Kirkpatrick AW, Laupland KB, Karmali S, et al. Spill your guts! Perceptions of Trauma Association of Canada member surgeons regarding the open abdomen and the abdominal compartment syndrome. J Trauma. 2006; 60: 279-86.
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND! J.J. De Waele, I. De laet & M.L.N.G. Malbrain To cite this article: J.J. De Waele, I. De laet & M.L.N.G. Malbrain (2007) INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!, Acta Clinica Belgica, 62:sup1, 6-8, DOI: 10.1179/ acb.2007.62.s1.002 To link to this article: http://dx.doi.org/10.1179/acb.2007.62.s1.002
Published online: 30 May 2014.
Submit your article to this journal
Article views: 2
View related articles
Citing articles: 4 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 Download by: [Orta Dogu Teknik Universitesi]
Date: 18 April 2016, At: 04:21
6
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!
Original article – OA 1
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND! Downloaded by [Orta Dogu Teknik Universitesi] at 04:21 18 April 2016
J.J. De Waele1, I. De laet2, M.L.N.G. Malbrain2
INTRODUCTION Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are relatively newly discovered problems in critically ill patients (1, 2), but in fact, they have been around since the early days of critical care medicine and even before. Many of us may well remember treating patients with tense, distended abdomens, after emergency abdominal surgery, or in patients suffering from diseases such as acute pancreatitis. Many patients who eviscerated in the intensive care unit (ICU) were sent back to the operating room for fascial closure, whereas these cases of spontaneous decompression should be seen as a natural defence mechanism and a sign that the physiology of the patient was compromised. All too often, the final common pathway was therapy resistant multiple organ dysfunc-
––––––––––––––– 1 Intensive Care Unit, Ghent University Hospital, Gent, Belgium; 2 Intensive Care Unit, Campus Stuivenberg, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium Address for correspondence: Jan J. De Waele, M.D. Intensive Care Unit 1K12-C Ghent University Hospital De Pintelaan 185 9000 Gent Belgium Tel: +32 9 240 27 75 Fax: +32 9 240 49 95 Email [email protected]
Acta Clinica Belgica, 2007; 62-Supplement 1
tion syndrome leading to exitus in the majority of these patients. So, why did we not think of IAH and ACS earlier? As you will read in the paper by Van Hee in this issue (3), the effects of IAH have been recognized for many years, but hardly got any attention from the physicians taking care of the most severely ill patients in the hospital. The first cases described in the era of modern critical care medicine date back to the early 1980s, when case series of patients dying from multiple organ dysfunction syndrome (MODS) after emergency surgical procedures were reported in the surgical literature (4, 5). The first descriptions of simple intraabdominal pressure (IAP) measurement techniques date from the same time period (6, 7). When looking back, the patients described in these early papers were pretty obvious cases of ACS, mostly after abdominal trauma or emergency abdominal surgery. This is where time stood still again. The majority of manuscripts that were published on the topic of IAH reiterated the classical face of ACS: the postoperative patient, hemodynamically unstable, oliguric and difficult to ventilate. The advent of laparoscopic surgery taught us that minor changes in IAP may also affect organ function, and that became the focus of intense research, especially in the second part of the 1990s. At the same time, more IAP measurement techniques were developed and became widely available (8). Finally the realization that minor elevations in IAP may also be relevant in the critically ill patient appeared (9, 10). All this renewed interest has resulted in an exponentially increasing number of publications on IAH and ACS and eventually in the foundation of the World Society for the Abdominal Compartment Syndrome (WSACS), a multidisciplinary organisation dedicated to foster
INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!
education and research on ACS. The WSACS has organised two World Congresses to this day and has published consensus definitions and recommendations on IAH and ACS (11, 12). The members of WSACS have also published a number of articles and editorials urging critical care specialists to pay attention to this complex problem (13-21).
Downloaded by [Orta Dogu Teknik Universitesi] at 04:21 18 April 2016
ARE WE PAYING ATTENTION NOW? A number of surveys have demonstrated that the awareness of the problem is high among intensivists and surgeons, at least in the individuals who took the time to fill out these questionnaires (22). This awareness will undoubtedly not be present in all intensivists or (trauma) surgeons who may be confronted with ACS, so the initial enthusiasm for the results of these surveys may be unwarranted. Especially in smaller hospitals where physicians and nurses are less frequently confronted with the problem of IAH and ACS, or with patients at risk for ACS, the level of awareness may be low. In the paper by Kimball et al., considerable differences existed between surgeons, internists and paediatricians: up to a quarter of paediatric and medical intensivists were unaware of common procedures such as bladder pressure measurement (23). But these questionnaires also raised another question: is awareness enough to effectively manage a patient with ACS? A considerable lack of knowledge was demonstrated by Kimball et al. who reported that the majority of the respondents believed that an IAP of 20-27mmHg was needed before physiologic compromise could occur (23). Moreover, considerable differences exist regarding the management of patients with IAH and ACS among physicians who consider themselves to be aware of the problem. In a survey of British hospitals, there was no agreement on the frequency or indications for IAP measurement, or indications for decompressive laparotomy (24). Kimball demonstrated that depending on the background of the critical care physician, strategies such as diuretics, paracentesis or the use of decompressive laparotomy were graded differently for the treatment of ACS (23). These findings may not be surprising given the lack of measurement guidelines and guidelines related to the management of these patients, which remains problematic. Kirckpatrick et al. reported that none of the members of the Canadian Trauma Association had a policy regarding the management of open abdomens (25).
The attention deficit still present in some ICU’s or in some intensivists is probably even more prominent outside the ICU. IAH may occur in the postoperative patient, who is in the post anaesthesia care unit or the general ward, and it may cause or contribute to organ dysfunction. IAH may be present in surgical patients who undergo emergency surgery for gastrointestinal obstruction, or in patients with chronic liver disease or acute pancreatitis in the gastroenterology ward. Whereas most physicians consider IAH and ACS to be an ICU problem, efforts should be made to educate at least everybody who takes care of patients with acute gastrointestinal problems. Table 1 estimates the likelihood of different medical specialties being confronted with IAH and ACS.
SO, WHERE DO WE GO FROM HERE? The ‘paying attention’ message has not lost its importance and we have to continue to bring this message, especially towards non critical care or surgery specialists. But at the same time, we need to move beyond this first step and bring another message to those who are already paying attention. The effects of elevated IAP have been described extensively, and they are summarized in a number of manuscripts in this supplement of Acta Clinica Belgica. IAH affects cardiovascular, pulmonary, renal, gastrointestinal and neurological function, and there is an evident association between the occurrence of IAH and ACS and mortality. It is evident from epidemiological studies that IAH and ACS are frequent findings in the ICU, not only in surgical patients, but also in medical patients and in children. However, in spite of all this recently acquired knowledge and all the efforts made, there are still important issues to be resolved. For example, there are still many uncertainties regarding optimal IAP measurement (the influence of patient positioning, the optimal timing of
Table 1. Likelihood of being confronted with IAH, ACS or patients at risk for IAH/ACS Very frequently Frequently
Often Occasionally
• • • • •
Intensivist Surgeon (trauma, GI) Anesthesiologist Emergency physician Surgeon (transplant, oncology, general, pediatric) • Gastroenterologist • Surgeon (thoracic, orthopedic)
Acta Clinica Belgica, 2007; 62-Supplement 1
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INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: WE HAVE PAID ATTENTION, NOW IT IS TIME TO UNDERSTAND!
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measurement, the value of continuous measurement, the importance of voluntary muscle activity in awake patients etc.), the temporal relationship between IAH and organ dysfunction is not clearly identified, a causal relationship between IAH and mortality has not been conclusively proven and many studies describing the relationship between IAH and organ dysfunction were conducted with outdated IAP measurement techniques and unreliable definitions for organ dysfunction. All these issues need to be studied soon, preferably before any attempts at treatment studies are undertaken.
CONCLUSION Insights in IAH and ACS are evolving rapidly. Paying attention is important, but it is only a first step towards the effective management of the patient with IAH and ACS. Understanding IAH is the next step, and treatment is the last one. Many questions remain to be solved regarding basic issues such as IAP measurement and the temporal relationship between IAH and organ dysfunction before we are really ready to tackle this complex syndrome. We should not try to run before we can walk.
REFERENCES 1. Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med. 1989; 17: 11821. 2. Schein M, Wittmann DH, Aprahamian CC, Condon RE. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. 1995; 180: 745-753. 3. Van Hee RH. Historical highlights in concept and treatment of abdominal compartment syndrome. Acta Clin Belg. 2007; 62: in press. 4. Richards WO, Scovill W, Shin B, Reed W. Acute renal failure associated with increased intra-abdominal pressure. 1983; 197: 183-7. 5. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. 1984; 199: 28-30. 6. Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. 1987; 15: 1140-2. 7. Iberti TJ, Lieber CE, Benjamin E. Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. 1989; 70: 47-50.
Acta Clinica Belgica, 2007; 62-Supplement 1
8. Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004; 30: 357-71. 9. Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005; 33: 315-22. 10. Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intraabdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004; 30: 822-9. 11. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006; 32: 1722-32. 12. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007; in press. 13. Balogh Z, De Waele JJ, Kirkpatrick A, Cheatham M, D’Amours S, Malbrain M. Intra-abdominal pressure measurement and abdominal compartment syndrome: The opinion of the World Society of the Abdominal Compartment Syndrome. Crit Care Med. 2007; 35: 677-8. 14. Malbrain ML. Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care. 2004; 10: 132-45. 15. Malbrain ML, Deeren D, De Potter TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care. 2005; 11: 156-71. 16. Ivatury RR. Abdominal compartment syndrome: a century later, isn’t it time to accept and promulgate? Crit Care Med. 2006; 34: 2494-5. 17. Ivatury RR, Sugerman HJ. Abdominal compartment syndrome: A century later, isn’t it time to pay attention? Crit Care Med. 2000; 28: 2137-8. 18. Sugrue M. Intra-abdominal pressure: time for clinical practice guidelines? Intensive Care Med. 2002; 28: 389-91. 19. Ball CG, Kirkpatrick AW. ‘Progression towards the minimum’: the importance of standardizing the priming volume during the indirect measurement of intra-abdominal pressures. Crit Care. 2006; 10: 153. 20. Malbrain M, Pelosi P. Open up and keep the lymphatics open: they are the hydraulics of the body! Crit Care Med. 2006; 34: 2860-2. 21. Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care. 2005; 11: 333-8. 22. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, De Waele J, Ivatury R. Abdominal compartment syndrome: it’s time to pay attention! Intensive Care Med. 2006; 32: 1912-4. 23. Kimball EJ, Rollins MD, Mone MC, et al. Survey of intensive care physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome. Crit Care Med. 2006; 34: 2340-8. 24. Ravishankar N, Hunter J. Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study. Br J Anaesth. 2005; 94: 763-6. 25. Kirkpatrick AW, Laupland KB, Karmali S, et al. Spill your guts! Perceptions of Trauma Association of Canada member surgeons regarding the open abdomen and the abdominal compartment syndrome. J Trauma. 2006; 60: 279-86.
