Intra-abdominal pressure measurement

Published: 11 December 2012

Improving clinical monitoring and patient safety through audit and implementation of a practice change

J. Martin, S. Cox, Critical Care Units, University Hospital Southampton NHS Foundation Trust, Southampton, UK

Article abstract

Intra-abdominal measurement is an emerging practice amongst intensive care units (ICUs). In the last decade, there has been a growing awareness of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) [1].  Clinical studies demonstrate that IAH, (defined as sustained or repeated IAP>12 mmHg) and ACS (defined as sustained IAP>20 mmHg and organ dysfunction/failure) are common pathological conditions in the ICU, with IAH occurring in more than 50 per cent of all surgical and medical ICU patients [2]. Although the effects of IAH and ACS on different organs can be life-threatening, it was only recently that the adverse consequences of the raised IAP were studied. IAH is associated with significantly increased morbidity and mortality [3], and with adverse affects on many organs [4]. These suggest the need for heightened awareness, early diagnosis and prompt treatment.

The ICU at University Hospitals Southampton NHS Foundation Trust decided to appraise current practice within its multi-professional team, and this led to an audit of 20 intravesical intra-abdominal pressure systems. This audit identified that instigating a device for measuring intra-abdominal pressure monitoring improves treatment of IAH, as well as having a financial cost saving.  Rollout has commenced on the ICU, making this the recognised management plan for suspected IAH, and the trust intends to introduce the system to the operating theatres for use with complex intra-abdominal surgical cases. The next 20 patients are being audited and the integrated teaching program continues. The hospital plans to develop this for use as a screening tool in patients.

References

1. World Society Abdominal Compartment Syndrome - www.wsacs.org (accessed August,2012)
2. Manu LNG Malbrain et al: Prevalence of intra-abdominal hypertension in critically ill patients: A multicentre epidemiological study. ICM 2004,
3. Manu LNG Malbrain et al: Incidence and prognosis of Intraabdominal hypertension in a mixed population of critically ill patients: A multicentre epidemiological study. CCM 2005 Vol. 33, No. 2.
4. Manu LNG Malbrain: Is it wise not to think about intra-abdominal hypertension in the ICU? Curr Opin Crit Care 2004; 10:132-145.

Contact details:

Sister – Jenna Martin – jenna.martin@uhs.nhs.uk
Charge Nurse – Stuart Cox – stuart.cox@uhs.nhs.uk

Full article

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