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Latest news on abdominal pressure monitoring. Jan J. De Waele MD PhD Surgical ICU Ghent University Hospital Ghent, Belgium. IAP monitoring??. Introduction. Fluid (over)load important contributor to IAH IAH and ACS identified as causes of organ dysfunction in critical care - PowerPoint PPT Presentation
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Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Latest news on abdominal pressure monitoring
Jan J. De Waele MD PhDSurgical ICU
Ghent University HospitalGhent, Belgium.
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP monitoring??
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Introduction• Fluid (over)load important contributor to
IAH• IAH and ACS identified as causes of organ
dysfunction in critical care
• IAP monitoring essential• Sole diagnostic tool
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Mon
itor I
AP•
Low
inde
x of
su
spic
ion
Prevent IAH• Operating theatre• Judicious fluid resuscitation • Open abdomen treatment
Medical management•IAP reducing strategies•Incorporate IAH in patient
management
Surgical m
anagemen
t•W
hen IAP>25m
mH
g•
Fulminant
deteriorationIAH management
in the ICU
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP measurement
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP measurement basics
Supine positionNo muscle contractionsOnly 25mL or lessTransvesicular approach
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Femoral vein pressure?
De Keulenaer BL, Intensive Care Med 2011
FVP cannot be used as a surrogate measure of IAP unless IAP is above 20 mmHg.
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
What is normal IAP?• Normal IAP 5-7mmHg• Effect of body weight?
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP and HOB positioningMost patients are nursed in 30-45°HOBEffect of positioning?
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP and prone positioning
• Zero reference level?• Abdominal support
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP and PEEP
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Pitfalls
Zero reference level• Inter-observer
differences• Mark the IAP
reference level on the patient!
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Pitfalls
Mass lesions in the pelvis – external compression
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
The abdomen as a hydraulic system
Is the abdomen a liquid filled container?
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP determinants
Gravity
Solid organs, fluid and gasRelevantDependent on volume and densityPascal’s law
Wall tension
• Abdominal wall + diaphragm• Relevant if compliance is low
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP determinants
Gravity Wall tension
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP
High compliance
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
IAP
Low compliance
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
So what?
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Explains organ dysfunction dynamics in IAH
First symptoms→ Kidney→ Hemodynamics
Later→ Respiratory
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Explains effect of positioning
Effect of HOB elevation?
IAP 16
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Explains effect of positioning
Effect of HOB elevation?
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Predicts effect of therapy
Role of abdominal decompression→ = increase in compliance of abdominal wall
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Conclusion• IAP measurement established
• IAP determinants• Pitfalls
• IAP measurement is simple• Effect of ICU interventions on IAP minimal
• Be careful when proning• New paradigms for *unexplained*
observations and therapy
Jan J. De Waele - Latest news on abdominal pressure monitoring – November 17th 2012
Thank you for your attention
Email: Jan.DeWaele@UGent.beTwitter: @JanDeWaeleMD
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