3 Reasons We Can’t Ignore Intra-Abdominal Pressure Readings
By Gregory Schears, MD | July 25, 2018
Intra-abdominal pressure (IAP) has been somewhat of a black box for many in healthcare today. Yet, we know that elevated IAP is often a mortality predictor in critically ill patients.1 I’ve been treating patients in critical care for decades, published in about 80 peer-reviewed articles, and have collaborated with colleagues across the country on various boards and associations related to emergency medicine. Somehow, though, we’re still not putting enough emphasis on one area of patient care in this setting. When a patient has a profoundly tight belly, critical care clinicians know there’s trouble as there’s no blood flow moving to their organs, but the reality is that IAP exists on a continuum from normal to very high. Obtaining this important data has been difficult and sometimes we leave it out of our tool box for managing critically ill patients.
We can’t ignore IAP anymore.
Data is available
The day has come we no longer have to rely on various, unreliable strange rigging of devices. The technology is now available to make better sense of what’s going on in the abdominal compartment. But we’ve spent too long ignoring IAP because of the difficulty in getting this accurate measurement. We should be excited by the insight that we’re going to gain. Better data is going to mean faster recognition of disease stages and result in better outcomes.
Standard of care
I believe IAP will and should be part of the standard of care because with new technology available, critical care nurses won’t need to jump through hoops to get the accurate reading as they did previously. For decades, we would get so much resistance from bedside providers saying that it was difficult to get these readings. The result was receiving measurements maybe every four hours at the most. Having this data should be part of the patient checklist, allowing physicians to more easily identify the direction of treatment.
Prevention of further patient issues
Being able to understand the pressure gradient that exists in the abdomen will also help us in managing these critically ill patients and hopefully avoid a case of abdominal compartment syndrome, which usually calls for an intervention of surgery. But we’re in an even stricter era of avoiding surgical site infections and longer hospital stays. So recognizing IAP moves us in toward that preventive approach for our patients.
By more precisely managing fluid, protecting and preserving organs, we’re going to have better outcomes in patients.
1. Intra-Abdominal Pressure: An Integrative Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234758/. Instituto de Ensino e Pesquisa Albert Einstein. July – September 2016. 1]↩
Gregory Schears, MD
Board Certified Anesthesiologist and Pediatrician
Gregory J. Schears, MD, is a board certified anesthesiologist and pediatrician practicing at a prestigious health system in Rochester, Minn., where he has been the recipient of their Distinguished Clinician Award. He also serves as a Professor of Anesthesiology, Medical Director of ECMO Services, and Co-Medical Director of the Cardiovascular Pediatric Surgical ICU. Dr. Schears is a member of numerous medical societies including the American Society of Anesthesiologists and the Society for Pediatric Anesthesia. He has been honored and recognized more than a dozen times by groups such as the Society of Critical Care Medicine. Dr. Schears earned his medical degree from the University of Wisconsin, and completed residencies at The Johns Hopkins Hospital and St. Louis Children’s Hospital.