INTRA ABDOMINAL PRESSURE

• IAP adalah status kekuatan tekanan di dalam rongga abdomen

NILAI IAP NORMAL DAN PATOLOGIK

• Normal IAP : 0 -5 mmHg (Sanchez NC dkk, 2001)

• Obesitas dan hamil : 10-15 mmHg : IAP kronik

• Critically Ill : 5-7 mmHg (Malbrain ML dkk, 2006)

INTRA ABDOMINAL HYPERTENSION

•IAH adalah kelainan patologik yang

berkembang dari waktu ke waktu
dengan tekanan > 12 mmHg

•Terdapat 4 gradasi
GRADING SYSTEM OF IAH AND DEVELOPMENT OF ACS

Grade Bladder pressure

(mmHg)
I 10 – 15
II 16 – 25
III 26 – 35
IV > 35

Meldrum DR, Moore FA, Moore FE, et al. Am J Surg 174: 667; 1997 .
1 mmHg = 1,26 cmH2O
Grading of IAP as determined by intravesical pressure, & summary of
clinical effects

(Midwinter, 2004)
Grade IAP (mmHg/ cmH2O) Clinical
I 7.3 – 11.0 (10-15) None
IIa 11.7 – 18.3 (16-25) Oliguria, splanchnic
hypoperfusion
IIIb 19.1 – 25.7 (26-35) Anuria,  ventilation
pressure
IVb >25.7 (>35) As above &  pO2
a
= initial th/ aims to restore splanchnic & renal hypoperfusion by
hypervolemic resuscitation
b
= these pts will probably require urgent abdominal decompression
 CARA PENGUKURAN IAP

• 92.3% Transvesikal
• 4.2% Langsung Intraperitoneal
• 2.8% Melalui Gaster

Sedang penelitian:
• 13.1% CT-Scan
• 10.1% Perimeter Abdomen
• 7.8% Ultrasonografi
 Measuring Intraabdominal Pressure (IAP)
• Direct Method
Directly placed a catheter into the peritoneal cavity, attaching to a
saline manometer or pressure transducer
• Indirect Method
Measurement of
• Bladder pressure  most popular
• Gastric pressure
• IVC pressure
Measurement of urinary bladder pressure with the U-Tube manometer
technique

Steven L.Lee et al, The Journal of Trauma, Injury, Infection and Critical Care,
Vol 52, No.52, June 2002
ORIGINAL IBERTI TECHNIQUE

Malbrain MLNG, Jones F:ACS.2006.Landes Bioscience

 Perimeter technique
Measuring girth diameter, increased 3 cm = 1000 cc Intra abdominal fluid
PERIMETER ABDOMEN

Malbrain MLNG, Jones F:ACS.2006.Landes Bioscience

PENILAIAN IAH DENGAN CT-
SCAN

Malbrain MLNG, Jones F:ACS.2006.Landes Bioscience

 CORRECT READING AT
END-EXPIRATION

Malbrain MLNG, Jones F:ACS.2006.Landes Bioscience

 INTRA-ABDOMINAL
HYPERTENSION

Pathological intra-abdominal pressure

• IAH is defined as a peak IAP value of > 12 mm Hg which is recorded by

minimum of two standardized pressure measurements that are conducted 1-6
hours apart
 ABDOMINAL COMPARTMENT
SYNDROME
• ACS is defined as a peak IAP value of > 20 mm Hg recorded during a minimum
of 2 standardized measurements that are performed 1-6 hours apart with
associated single or multiple organ system failure which was not previously
present