INTRA-ABDOMINAL

HYPERTENSION
Andrew William L. Aquino
 WHAT IS INTRA-
ABDOMINAL PRESSURE?
•Intra-abdominal pressure is defined as “a
steady – state pressure concealed within
the abdominal cavity
 WHAT IS INTRA-ABDOMINAL
HYPERTENSION?
• Intra-abdominal Hypertension (IAH) is diagnosed
when a patient has three documented IAP
measurements of 12-20 mmhg, 4-6 hours apart.
• IAH, if not treated will progressively develop into
Abdominal Compartment Syndrome (ACS).
 HOW TO GRADE INTRA-
ABDOMINAL HYPERTENSION?

•Grade I, IAP 12-15 mmHg

•Grade II, IAP 16-20 mmHg
•Grade III, IAP 21-25 mmHg
•Grade IV, IAP > 25 mmHg
 RISK FACTORS FOR DEVELOPING
IAH
• Abdominal surgery
• Anemia
• Acidemia
• Acute pancreatitis
• gastroparesis/ Gastric/ Ileus
• Hemoperitoneum or pneumoperitoneum or intraperitoneal fluid collection
• Hypothermia
• Increased head of the bed angle
• Intraabdominal infection
 RISK FACTORS FOR DEVELOPING
IAH
• Liver dysfunction/cirrhosis with ascites
• Major trauma
• Massive fluid resuscitation or fluid overload
• Mechanical ventilation
• Obesity and increased BMI
• PEEP>10
• Poly-transfusion
• Prone positioning
• Sepsis
• Shock or hypotension
 HOW TO MEASURE THE IAP
• IAP should be expressed in mmHg and
measured at end-expiration in the
complete supine position after
ensuring that abdominal muscle
contractions are absent and with the
transducer zeroed at the level of the
midaxillary line.
 THE GOLD STANDARD FOR IAP
MEASUREMENT
• IAP monitoring using Foley’s catheter is known as gold
standard where urinary bladder is acting medium for the
monitoring
• Intermittent or continuous IAP monitoring using bladder
is the most commonly used and the recommended
method.
 WHAT IS OUR WORK
INSTRUCTION?
• We use intermittent monitoring using Unometer - Abdominal Pressure
Kit.
• When two or more risk factors are present, and at the request of the
intensive care consultant a baseline IAP should be recorded
• If IAH is present, serial measurements should be performed through out
the patient’s critical illness.
• Measurement should be taken at least four hours
• Change the system every 7days.
 EQUIPMENTS
• Indwelling urinary catheter (IDC) – already insitu, in most cases, if not a new
urinary catheter insertion kit in needed.
• 1 x new metered urinary drainage bag
• UnoMeter Abdo-Pressure Kit
• Sterile Drape
• Alcowipes or Chlorhexidine solution and gauze
• Sterile gloves
• Skin Marker Pen
 HOW TO CONNECT TO A EXISTING
IDC?
• The disconnection of the closed of the closed urine drainage system must be
performed under sterile conditions.
• Use sterile filed, gloves, and antiseptic solution
• Perform hand wash
• Unpack the Unometer tubing and close the red clamp
• Attach UnoMeter Pressure between the patients IDC and the Urine drainage bag
• Place tubing around patients leg without loops
 IAP MEASUREMENT
• Clean the IDC latex port with an AlcoWipe
• Prime UnoMeter with 20ml sterile 0.9% saline
• Place zero point on tubing next to patients reference point
• Open the red clamp. Measure intra-abdominal pressure
• Close the red clamp. Place tubing around patients leg without loops.
• Document pressure under “abdominal Pressure” on the Metavision
Neurovascular Observations.
 THE PRINCIPLES OF IAP
MEASUREMENT
• Expressed in mmHg (scaling on Unometer Abdo-pressure kit is in
mmHg)
• Measured in end-expiration
• Performed in supine position
• Performed with an instillation volume of 20ml of NaCl 0.9%
• Measured 30-60 seconds after instillation to allow for bladder detrusor
muscle relaxation
• Measured in the absence of active abdominal muscle contractions
THANK YOU PO!