Intraabdominelle Druckmessung – Schritt für Schritt

Die intraabdominelle Hypertension und das abdominelle Kompartmentsyndrom werden nicht immer erkannt. Dabei stellen sie ein häufiges Problem bei Intensivpatienten dar und gehen mit erhöhter Mortalität und Morbidität sowie verlängerter Intensivtherapie einher. Zur Diagnosestellung ist die Blasendruckmessung als Goldstandard eine nichtinvasive, kostengünstige, einfach bettseitig durchführbare und sichere Methode.

Abstract

An elevated intra-abdominal pressure (IAP) above 12 mmHg is a pathological finding in critically ill patients. IAP are classified into different degrees of intra-abdominal hypertension and, in the presence of associated organ failure, as abdominal compartment syndrome. Both disease entities represent an underestimated factor in intensive care patients and are associated with increased mortality and prolonged intensive care and hospital stay. The measurement of intra-abdominal pressure in critically ill patients in intensive care units is not widely established and there is often considerable uncertainty regarding measurement conditions and methods. If risk factors are present, intra-abdominal pressure should be monitored every 4 hours. Bladder pressure measurement is the gold standard for determining intra-abdominal pressure. The measurement is a non-invasive, cost-effective, easy to perform bedside and safe method for the patient.

Schlüsselwörter

abdominelles Kompartmentsyndrom - Blasendruckmessung - intraabdominelle Hypertension

Key words

abdominal compartment syndrome - bladder pressure measurement - intraabdominal hypertension

Publication History

Article published online:
14 September 2021

• Literatur

• 1 Cheatham ML. Abdominal compartment syndrome: pathophysiology and definitions. Scand J Trauma Resusc Emerg Med 2009; 17: 10
• 2 Kirkpatrick AW, Roberts DJ, De Waele J. et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intens Care Med 2013; 39: 1190-1206
• 3 Coccolini F, Biffl W, Catena F. et al. The open abdomen, indications, management and definitive closure. World J Emerg Surg 2015; 10: 32
• 4 Chopra SS, Wolf S, Rohde V. et al. Pressure Measurement Techniques for Abdominal Hypertension: Conclusions from an Experimental Model. Crit Care Res Pract 2015; 2015: 278139
• 5 Holodinsky JK, Roberts DJ, Ball CG. et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care 2013; 17: R249
• 6 Cheatham ML. Intraabdominal pressure monitoring during fluid resuscitation. Curr Opin Crit Care 2008; 14: 327-333
• 7 Padar M, Reintam Blaser A, Talving P. et al. Abdominal Compartment Syndrome: Improving Outcomes With A Multidisciplinary Approach – A Narrative Review. J Multidiscip Healthc 2019; 12: 1061-1074
• 8 Iyer D, Rastogi P, Åneman A. et al. Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand 2014; 58: 1267-1275
• 9 Murphy PB, Parry NG, Sela N. et al. Intra-Abdominal Hypertension Is More Common Than Previously Thought: A Prospective Study in a Mixed Medical-Surgical ICU. Crit Care Med 2018; 46: 958-964
• 10 Reintam Blaser A, Regli A, De Keulenaer B. et al. Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study). Crit Care Med 2019; 47: 535-542
• 11 Smit M, Koopman B, Dieperink W. et al. Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU. Ann Intensive Care 2020; 10: 130
• 12 Milanesi R, Caregnato RC. Intra-abdominal pressure: an integrative review. Einstein (Sao Paulo) 2016; 14: 423-430
• 13 Arabadzhiev GM, Tzaneva VG, Peeva KG. Intra-abdominal hypertension in the ICU – a prospective epidemiological study. Clujul Med 2015; 88: 188-195
• 14 Kirkpatrick AW, De Waele JJ, De Laet I. et al. WSACS – The Abdominal Compartment Society. A Society dedicated to the study of the physiology and pathophysiology of the abdominal compartment and its interactions with all organ systems. Anaesthesiol Intens Ther 2015; 47: 191-194
• 15 Rajasurya V, Surani S. Abdominal compartment syndrome: Often overlooked conditions in medical intensive care units. World J Gastroenterol 2020; 26: 266-278
• 16 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
• 17 Al-Abassi AA, Al Saadi AS, Ahmed F. Is intra-bladder pressure measurement a reliable indicator for raised intra-abdominal pressure? A prospective comparative study. BMC Anesthesiol 2018; 18: 69
• 18 Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984; 199: 28-30
• 19 Gudmundsson FF, Viste A, Gislason H. et al. Comparison of different methods for measuring intra-abdominal pressure. Intens Care Med 2002; 28: 509-514
• 20 Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 2001; 50: 297-302
• 21 Johna S, Taylor E, Brown C. et al. Abdominal compartment syndrome: does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients. Crit Care 1999; 3: 135-138
• 22 De Laet IE, Malbrain MLNG, De Waele JJ. A Clinician's Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care 2020; 24: 97
• 23 Malbrain ML, Deeren DH. Effect of bladder volume on measured intravesical pressure: a prospective cohort study. Crit Care 2006; 10: R98
• 24 Desie N, Willems A, De Laet I. et al. Intra-abdominal pressure measurement using the FoleyManometer does not increase the risk for urinary tract infection in critically ill patients. Ann Intens Care 2012; 2 (Suppl. 01) S10