Abdominal Compartment Syndrome & Intrabdominal Pressure Measurement APP (Abdominal Perfusion Pressure) = MAP (Mean Arterial Pressure) - IAP (Intra-Abdominal Pressure) Intra-Abdominal Pressure (IAP) is the pressure within the abdomen, reflecting the outward pressure of abdominal contents & inward pressure of the abdominal wall. Intra-Abdominal Hypertension (IAH) is IAP (>12 mmHg) due to underlying pathology. Abdominal Compartment Syndrome (ACS): is the physiologic consequence of an IAP >20 mmHg causing organ dysfunction; it also compromises venous return to the heart (reduced CO) and impedes lung expansion. ACS can be divided into: - Primary (due to organ edema, pancreatitis, accumulation of intrabdominal or retroperitoneal fluid, etc) - Secondary (due to sepsis, excessive fluid resuscitation, circumferential abdomen burns, etc) - Chronic (due to long standing ascites, mass, Meig's syndrome, peritoneal dialysis, etc) - Recurrent (development of ACS after previous treatment) MEASURING BLADDER PRESSURE AS A SURROGATE FOR IAP 1. Place the patient in a supine position 2. Ensure correct placement (e.g. POCUS) and function of Foley urinary catheter (e.g. flushes) 3. Connect a transducer, flush syringe, and pressure bag to the Foley side port 4. Zero the transducer at the level with the mid-axillary line 5. Clamp catheter distal to the port with a padded hemostat 6. Turn the stopcock off to the patient allowing syringe to fill with IV fluid from pressure bag 7. Turn the stopcock back on to patient and inject the filled syringe into bladder 8. Release hemostat clamp on foley to allow flushing of air from the urinary catheter 9. Wait up to 1 minute to allow bladder detrusor muscle relaxation to occur 10. Measure IAP in end-expiratory phase either continuously or every 4-6 hours by Mark Ramzy, DO, EMT-P @MRamzyDO and Nick Mark MD @NickmMark #Abdominal #Compartment #Syndrome #IAP #Intrabdominal #Pressure #Measurement #Instructions #diagnosis
