International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome

Prashant Nasa, Department of Anaesthesia and Critical Care Medicine, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, UK. dr.prashantnasa@hotmail.com.
Robert D. Wise, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1050, Brussels, Belgium.
Marije Smit, Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Stefan Acosta, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
Scott D'Amours, Trauma and Acute Care Surgery Unit, Liverpool Hospital, Sydney, Australia.
William Beaubien-Souligny, Department of Medicine, Nephrology Division, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, Canada.
Zsolt Bodnar, Department of Surgery, Letterkenny University Hospital, Donegal, Ireland.
Federico Coccolini, General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
Neha S. Dangayach, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Wojciech Dabrowski, First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
Juan Duchesne, Division Chief Trauma/Acute Care and Critical Care Department of Surgery, Tulane University, New Orleans, LA, USA.
Janeth C. Ejike, Department of Pediatrics, Downey Medical Center, Southern California Permanente Medical Group, 9333 Imperial Highway, Downey, CA, 90242, USA.
Goran Augustin, Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
Bart De Keulenaer, Department of Intensive Care, Fiona Stanley Hospital, Murdoch, Australia.
Andrew W. Kirkpatrick, Department of Surgery and Critical Care Medicine, Regional Trauma Services Foothills Medical Centre, Calgary, AB, T2N 2T9, Canada.
Ashish K. Khanna, Department of Anesthesiology, Section On Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Edward Kimball, Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, USA.
Abhilash Koratala, Division of Nephrology Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA.
Rosemary K. Lee, Baptist Health South Florida, Coral Gables, Florida, USA.
Ari Leppaniemi, Department of Abdominal Surgery, Meilahti Hospital, University of Helsinki, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland.
Edgar V. Lerma, Advocate Health - Midwest
et al

Affiliations

Advocate Christ Medical Center

Abstract

Background:The Abdominal Compartment Society (WSACS) established consensus definitions and recommendations for the management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in 2006, and they were last updated in 2013. The WSACS conducted an international survey between 2022 and 2023 to seek the agreement of healthcare practitioners (HCPs) worldwide on current and new candidate statements that may be used for future guidelines.

Methods:A self-administered, online cross-sectional survey was conducted under the auspices of the WSACS to assess the level of agreement among HCPs over current and new candidate statements. The survey, distributed electronically worldwide, collected agreement or disagreement with statements on the measurement of intra-abdominal pressure (IAP), pathophysiology, definitions, and management of IAH/ACS. Statistical analysis assessed agreement levels, expressed in percentages, on statements among respondents, and comparisons between groups were performed according to the respondent's education status, base specialty, duration of work experience, role (intensivist vs non-intensivist) and involvement in previous guidelines. Agreement was considered to be reached when 80% or more of the respondents agreed with a particular statement.

Results:A total of 1042 respondents from 102 countries, predominantly physicians (73%), of whom 48% were intensivists, participated. Only 59% of HCPs were aware of the 2013 WSACS guidelines, and 41% incorporated them into practice. Despite agreement in most statements, significant variability existed. Notably, agreement was not reached on four new candidate statements: "normal intra-abdominal pressure (IAP) is 10 mmHg in critically ill adults" (77%), "clinical assessment and estimation of IAP is inaccurate" (65.2%), "intragastric can be an alternative to the intravesical route for IAP measurement" (70.4%), and "measurement of IAP should be repeated in the resting position after measurement in a supine position" (71.9%). The survey elucidated nuances in clinical practice and highlighted areas for further education and standardization.

Conclusion:More than ten years after the last published guidelines, this worldwide cross-sectional survey collected feedback and evaluated the level of agreement with current recommendations and new candidate statements. This will inform the consensus process for future guideline development.

Document Type

Article

PubMed ID

39609850

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