. 2024 Nov 29;19(1):39.

doi: 10.1186/s13017-024-00564-5.

International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome

Prashant Nasa^#¹, Robert D Wise^#^{2

3

4}, Marije Smit⁵, Stefan Acosta⁶, Scott D'Amours^{7

8}, William Beaubien-Souligny⁹, Zsolt Bodnar¹⁰, Federico Coccolini¹¹, Neha S Dangayach¹², Wojciech Dabrowski¹³, Juan Duchesne¹⁴, Janeth C Ejike^{15

16}, Goran Augustin¹⁷, Bart De Keulenaer^{18

19}, Andrew W Kirkpatrick²⁰, Ashish K Khanna^{21

22}, Edward Kimball²³, Abhilash Koratala²⁴, Rosemary K Lee²⁵, Ari Leppaniemi²⁶, Edgar V Lerma²⁷, Valerie Marmolejo²⁸, Alejando Meraz-Munoz²⁹, Sheila N Myatra³⁰, Daniel Niven³¹, Claudia Olvera³², Carlos Ordoñez^{33

34}, Clayton Petro³⁵, Bruno M Pereira^{36

37}, Claudio Ronco^{38

39}, Adrian Regli^{40

41

42}, Derek J Roberts⁴³, Philippe Rola⁴⁴, Michael Rosen³⁵, Gentle S Shrestha⁴⁵, Michael Sugrue⁴⁶, Juan Carlos Q Velez⁴⁷, Ron Wald^{48

49}, Jan De Waele^{50

51}, Annika Reintam Blaser^#^{52

53}, Manu L N G Malbrain^#^{13

54

55}

Affiliations

¹ Department of Anaesthesia and Critical Care Medicine, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, UK. dr.prashantnasa@hotmail.com.
² Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1050, Brussels, Belgium.
³ Discipline of Anesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa.
⁴ Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
⁵ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁶ Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
⁷ Trauma and Acute Care Surgery Unit, Liverpool Hospital, Sydney, Australia.
⁸ The University of New South Wales- South West Clinical School, Sydney, Australia.
⁹ Department of Medicine, Nephrology Division, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, Canada.
¹⁰ Department of Surgery, Letterkenny University Hospital, Donegal, Ireland.
¹¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
¹² Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹³ First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
¹⁴ Division Chief Trauma/Acute Care and Critical Care Department of Surgery, Tulane University, New Orleans, LA, USA.
¹⁵ Department of Pediatrics, Downey Medical Center, Southern California Permanente Medical Group, 9333 Imperial Highway, Downey, CA, 90242, USA.
¹⁶ Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA.
¹⁷ Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
¹⁸ Department of Intensive Care, Fiona Stanley Hospital, Murdoch, Australia.
¹⁹ Department of Surgery, The University of Western Australia, Perth, WA, Australia.
²⁰ Department of Surgery and Critical Care Medicine, Regional Trauma Services Foothills Medical Centre, Calgary, AB, T2N 2T9, Canada.
²¹ Department of Anesthesiology, Section On Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
²² Outcomes Research Consortium, Houston, TX, USA.
²³ Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, USA.
²⁴ Division of Nephrology Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA.
²⁵ Baptist Health South Florida, Coral Gables, Florida, USA.
²⁶ Department of Abdominal Surgery, Meilahti Hospital, University of Helsinki, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland.
²⁷ Department of Medicine, Advocate Christ Medical Center, University of Illinois at Chicago, Oak Lawn, IL, USA.
²⁸ DPM, MS, Medical Writer, Scriptum Medica, Washington, USA.
²⁹ Division of Nephrology, St. Boniface Hospital and The University of Manitoba, Winnipeg, MB, Canada.
³⁰ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
³¹ Departments of Critical Care Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
³² The American British Cowdray Medical Center, Universidad Anahuac, Mexico City, Mexico.
³³ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia.
³⁴ Sección de Cirugía de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
³⁵ Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA.
³⁶ University of Vassouras, Rio de Janeiro, Brazil.
³⁷ General Surgery Residency Program, Santa Casa de Campinas, Rio de Janeiro, Brazil.
³⁸ Department of Nephrology and the International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.
³⁹ University of Padova, Padua, Italy.
⁴⁰ Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia.
⁴¹ Medical School, The Notre Dame University, Fremantle, WA, Australia.
⁴² Medical School, The University of Western Australia, Perth, WA, Australia.
⁴³ Departments of Surgery and Community Health Sciences, University of Calgary, Calgary, AB, T2N 5A1, Canada.
⁴⁴ Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada.
⁴⁵ Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
⁴⁶ Letterkenny University Hospital, Donegal, Ireland.
⁴⁷ Ochsner Medical Center, New Orleans, LA, USA.
⁴⁸ Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Canada.
⁴⁹ Department of Nephrology and Hypertension, Tel Aviv Medical Center, Tel Aviv, Israel.
⁵⁰ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
⁵¹ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁵² Clinic of Anesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
⁵³ Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
⁵⁴ Medical Data Management, Medaman, Geel, Belgium.
⁵⁵ International Fluid Academy, Lovenjoel, Belgium.

^# Contributed equally.

PMID: 39609850
PMCID: PMC11605967
DOI: 10.1186/s13017-024-00564-5

International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome

Prashant Nasa et al. World J Emerg Surg. 2024.

. 2024 Nov 29;19(1):39.

doi: 10.1186/s13017-024-00564-5.

Authors

Affiliations

¹ Department of Anaesthesia and Critical Care Medicine, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, UK. dr.prashantnasa@hotmail.com.
² Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1050, Brussels, Belgium.
³ Discipline of Anesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa.
⁴ Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
⁵ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁶ Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
⁷ Trauma and Acute Care Surgery Unit, Liverpool Hospital, Sydney, Australia.
⁸ The University of New South Wales- South West Clinical School, Sydney, Australia.
⁹ Department of Medicine, Nephrology Division, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, Canada.
¹⁰ Department of Surgery, Letterkenny University Hospital, Donegal, Ireland.
¹¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
¹² Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹³ First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
¹⁴ Division Chief Trauma/Acute Care and Critical Care Department of Surgery, Tulane University, New Orleans, LA, USA.
¹⁵ Department of Pediatrics, Downey Medical Center, Southern California Permanente Medical Group, 9333 Imperial Highway, Downey, CA, 90242, USA.
¹⁶ Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA.
¹⁷ Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
¹⁸ Department of Intensive Care, Fiona Stanley Hospital, Murdoch, Australia.
¹⁹ Department of Surgery, The University of Western Australia, Perth, WA, Australia.
²⁰ Department of Surgery and Critical Care Medicine, Regional Trauma Services Foothills Medical Centre, Calgary, AB, T2N 2T9, Canada.
²¹ Department of Anesthesiology, Section On Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
²² Outcomes Research Consortium, Houston, TX, USA.
²³ Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, USA.
²⁴ Division of Nephrology Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA.
²⁵ Baptist Health South Florida, Coral Gables, Florida, USA.
²⁶ Department of Abdominal Surgery, Meilahti Hospital, University of Helsinki, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland.
²⁷ Department of Medicine, Advocate Christ Medical Center, University of Illinois at Chicago, Oak Lawn, IL, USA.
²⁸ DPM, MS, Medical Writer, Scriptum Medica, Washington, USA.
²⁹ Division of Nephrology, St. Boniface Hospital and The University of Manitoba, Winnipeg, MB, Canada.
³⁰ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
³¹ Departments of Critical Care Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
³² The American British Cowdray Medical Center, Universidad Anahuac, Mexico City, Mexico.
³³ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia.
³⁴ Sección de Cirugía de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
³⁵ Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA.
³⁶ University of Vassouras, Rio de Janeiro, Brazil.
³⁷ General Surgery Residency Program, Santa Casa de Campinas, Rio de Janeiro, Brazil.
³⁸ Department of Nephrology and the International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.
³⁹ University of Padova, Padua, Italy.
⁴⁰ Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia.
⁴¹ Medical School, The Notre Dame University, Fremantle, WA, Australia.
⁴² Medical School, The University of Western Australia, Perth, WA, Australia.
⁴³ Departments of Surgery and Community Health Sciences, University of Calgary, Calgary, AB, T2N 5A1, Canada.
⁴⁴ Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada.
⁴⁵ Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
⁴⁶ Letterkenny University Hospital, Donegal, Ireland.
⁴⁷ Ochsner Medical Center, New Orleans, LA, USA.
⁴⁸ Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Canada.
⁴⁹ Department of Nephrology and Hypertension, Tel Aviv Medical Center, Tel Aviv, Israel.
⁵⁰ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
⁵¹ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁵² Clinic of Anesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
⁵³ Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
⁵⁴ Medical Data Management, Medaman, Geel, Belgium.
⁵⁵ International Fluid Academy, Lovenjoel, Belgium.

^# Contributed equally.

PMID: 39609850
PMCID: PMC11605967
DOI: 10.1186/s13017-024-00564-5

Abstract

Background: The Abdominal Compartment Society (WSACS) established consensus definitions and recommendations for the management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in 2006, and they were last updated in 2013. The WSACS conducted an international survey between 2022 and 2023 to seek the agreement of healthcare practitioners (HCPs) worldwide on current and new candidate statements that may be used for future guidelines.

Methods: A self-administered, online cross-sectional survey was conducted under the auspices of the WSACS to assess the level of agreement among HCPs over current and new candidate statements. The survey, distributed electronically worldwide, collected agreement or disagreement with statements on the measurement of intra-abdominal pressure (IAP), pathophysiology, definitions, and management of IAH/ACS. Statistical analysis assessed agreement levels, expressed in percentages, on statements among respondents, and comparisons between groups were performed according to the respondent's education status, base specialty, duration of work experience, role (intensivist vs non-intensivist) and involvement in previous guidelines. Agreement was considered to be reached when 80% or more of the respondents agreed with a particular statement.

Results: A total of 1042 respondents from 102 countries, predominantly physicians (73%), of whom 48% were intensivists, participated. Only 59% of HCPs were aware of the 2013 WSACS guidelines, and 41% incorporated them into practice. Despite agreement in most statements, significant variability existed. Notably, agreement was not reached on four new candidate statements: "normal intra-abdominal pressure (IAP) is 10 mmHg in critically ill adults" (77%), "clinical assessment and estimation of IAP is inaccurate" (65.2%), "intragastric can be an alternative to the intravesical route for IAP measurement" (70.4%), and "measurement of IAP should be repeated in the resting position after measurement in a supine position" (71.9%). The survey elucidated nuances in clinical practice and highlighted areas for further education and standardization.

Conclusion: More than ten years after the last published guidelines, this worldwide cross-sectional survey collected feedback and evaluated the level of agreement with current recommendations and new candidate statements. This will inform the consensus process for future guideline development.

Keywords: Abdominal compartment syndrome; Abdominal hypertension; Abdominal pressure; Definitions; Management; Pathophysiology; Survey.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The international survey was initiated by the Abdominal Compartment Society (WSACS, www.wsacs.org ), and conducted with voluntary participation of healthcare professionals. Protection of participants’ data was ensured under the General Data Protection Regulation (GDPR) of the European Union. The study was designed as a low-risk research project, focusing on personal opinion data collection through an online anonymous survey. The survey methodology and subsequent data analysis were conducted following the ethical principles outlined in the Declaration of Helsinki, which emphasizes respect for individuals, their right to make informed decisions, and the confidentiality of their personal data. Consent was implied upon completion of the survey for participation, anonymized data processing, and publication of the results. Competing interests: ARB received speaker or consultancy fee from Nutricia and VIPUN Medical and is holding a grant from the Estonian Research Council (Grant number PRG1255). MLNGM is a member of the medical advisory Board of Pulsion Medical Systems (fully part of the Getinge group), Serenno Medical, Potrero Medical, Sentinel Medical and Baxter. He consults for BBraun, Becton Dickinson, ConvaTec, Spiegelberg, Medtronic, MedCaptain, and Holtech Medical and receives speaker fees from PeerVoice. He holds stock options for Serenno and Potrero. He is a cofounder and President of the International Fluid Academy (IFA). The IFA ( http://www.fluidacademy.org ) is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law. The remaining authors have no conflicts of interest.

Figures

**Fig. 1**
Geographical representation of the respondents of the cross-sectional survey

**Fig. 2**
Respondents’ agreement with statements related to the pathophysiology of intra-abdominal hypertension and measurement of intraabdominal pressure. MAP: mean arterial pressure, IAP: intrabdominal pressure, FG: filtration gradient, GFP: glomerular filtration pressure, APP: abdominal perfusion pressure, PTP: proximal tubular pressure, Cab: abdominal compliance, RVP: renal venous pressure, IAPei: IAP end-inspiratory, IAPee: IAP end-expiratory, HOB: head-of-bed, RAV: respiratory-abdominal variation, (new) are candidate statements for future revision of guidelines

**Fig. 3**
Respondents’ agreement with statements related to the definition and management of intra-abdominal hypertension and abdominal compartment syndrome. ACS: abdominal compartment syndrome, IAH: intrabdominal hypertension, IAP: intrabdominal pressure, APP: abdominal perfusion pressure, SOFA: sequential failure organ assessment, qSOFA: quick SOFA, TAC: temporary abdominal closure, (new) in the parenthesis are candidate statements for future revision of guidelines

**Fig. 4**
Distribution of respondents’ opinions on the future role of the Abdominal Compartment Society, WSACS: Abdominal Compartment Society

See this image and copyright information in PMC

References

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International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome

Affiliations

International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials