Survey of intensive care physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome.

OBJECTIVE

To assess current understanding and clinical management of intra-abdominal hypertension and abdominal compartment syndrome among critical care physicians.

DESIGN

A ten-question, written survey.

SETTING

University health sciences center.

SUBJECTS

Physician members of the Society of Critical Care Medicine (SCCM).

INTERVENTIONS

The survey was sent to 4,538 SCCM members with a response rate of 35.7% (1622).

MEASUREMENTS AND MAIN RESULTS

Primary training, intensive care unit type, and methods for management of abdominal compartment syndrome were assessed. Surgically trained intensivists managed the highest number of abdominal compartment syndrome cases (47% managed 4-10 cases, 16% managed >10 cases). No cases were seen by 25% of medically trained and pediatric trained intensivists. Respondents agreed that bladder pressures and clinical variables were needed to diagnose abdominal compartment syndrome (70%) vs. bladder pressure (7%) or clinical variables (20%) alone. Two percent of surgical intensivists were unaware of a bladder pressure measurement procedure compared with 24% (p < .0001) of pediatric and 23% (p < .0001) of medical intensivists. Forty-two percent of respondents believed bladder pressures of 20-27 mm Hg may cause physiologic compromise. However, 25-27% of pediatric, medicine, or anesthesia trained intensivists believed that compromise occurs between 12 and 19 mm Hg compared with 18% of surgeons. No respondent believed that physiologic compromise occurred at <8 mm Hg. Thirty-eight percent of pediatric intensivists believed that physiologic compromise was patient dependent vs. 7-17% from other specialties (p < .0001; all comparisons). In managing intra-abdominal hypertension, 33% of pediatric intensivists and 19.6% of medical intensivists would never use decompression laparotomy to treat abdominal compartment syndrome compared with 3.6% of intensivists with surgical training (p < .0001; both comparisons).

CONCLUSIONS

Significant variation across medical training exists in the management of intra-abdominal hypertension and abdominal compartment syndrome. A significant percentage of intensivists may be unaware of current approaches to abdominal compartment syndrome management including monitoring bladder pressures and decompression laparotomy. Future research and education are necessary to establish clear diagnostic criteria and standards for treatment of this relatively common life-threatening disease process.