The measurement of intra-abdominal pressure in intensive care indications and nursing management
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Abstract
Intra-abdominal pressure (Intra Abdominal Pressure - IAP) is defined as the pressure inside the abdominal cavity at the steady state.
Abdominal hypertension (IHA) is an often underestimated but frequent problem in intensive care; the prevalence of abdominal compartment syndrome (ACS) in the intensive care units ranges from 1 to 15%, while that of intraabdominal hypertension ranges from 2 to 33% depending on the type of patients, the average length of stay and the therapies used.
The pathological increase in intraabdominal pressure has a negative impact on all organs and systems, causing dysfunctionality and insufficiency.
The measurement of IAP allows an early diagnosis of abdominal hypertension, it is a parameter whose monitoring is becoming increasingly widespread in the daily practice of intensive care and beyond.
ACS can develop due to a variety of causes; it is therefore impossible to apply a standardized therapeutic strategy.
However, the following principles are essential for the appropriate management of all patients:
1) serial monitoring of the IAP at least every 4 hours, or more frequently if necessary;
2) optimization of systemic perfusion and organ function in patients with increased IAP;
3) establishment of medical strategies;
4) surgical decompression for refractory ACS.
Specific nursing management for patients with ACS involves the assessment of organ dysfunction and ACS risk factors and the measurement of IAP at regular intervals.
Nursing management of patients with IAH or ACS is particularly complex and requires clinical experience.
It is oriented to guarantee:
• hemodynamic monitoring, assessment of vital signs, filling pressures and signs of perfusion (temperature and color of the extremities);
• pain management;
• from drainage management;
• the water balance;
• Electrolytic and acid-base monitoring;
• Psychological support for patients and their families.
The management of the IAH / ACS and the monitoring of the IAP, due to its clinical implications and its complexity, requires experienced nurses possessing advanced skills, in-depth knowledge, decisionmaking ability and critical thinking.
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