Doudakmanis Christos, Makris Demosthenes
Department of Critical Care Medicine, University Hospital of Larissa, Larissa, GRC.
Second Propaedeutic Department of Surgery, Laiko General Hospital of Athens, Athens, GRC.
Cureus. 2025 Mar 28;17(3):e81370. doi: 10.7759/cureus.81370. eCollection 2025 Mar.
Increased intra-abdominal pressure (IAP) is a significant clinical concern, which has been proven to cause significant adverse events in patients. Respiratory infections are a high-yield problem in the intensive care unit (ICU). In this study, we reviewed available literature regarding the relationship between elevated IAP and the development of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Patients with prolonged mechanical ventilation are prone to develop VAP. Longer hospitalization, prior use of antibiotics, and comorbidities make these patients more susceptible to infections. Multidrug-resistant VAP poses a vast threat to critically ill patients, as it is characterized by a shift in the microbiological profile of the disease, as well as difficulties in its treatment options. Elevated IAP could adversely affect mechanically ventilated patients, as it is associated with an elevated risk of microaspirations and altered patency of the intestinal barrier, thus comprising an important factor for developing VAP. In addition, elevated IAP can deteriorate pulmonary function and hemodynamic condition of the patient, adding an extra risk for developing VAP. In such frail conditions, these patients have compromised immune function and are at risk of developing systematic infection, even resulting in the failure of multiple organs. As the microbiologic profile shifts toward multidrug-resistant bacteria, there is a need for comprehensive strategies in ICU settings to mitigate the risks associated with both elevated IAP and multidrug-resistant VAP. Timely intervention and proper management can prevent the risk of difficult-to-treat infections and life-threatening adverse events for patients.
腹腔内压力（IAP）升高是一个重大的临床问题，已被证明会在患者中引发严重不良事件。呼吸道感染是重症监护病房（ICU）中的一个常见问题。在本研究中，我们回顾了关于机械通气患者中IAP升高与呼吸机相关性肺炎（VAP）发生之间关系的现有文献。机械通气时间延长的患者容易发生VAP。住院时间延长、先前使用抗生素以及合并症使这些患者更容易受到感染。多重耐药性VAP对重症患者构成巨大威胁，因为其特点是疾病微生物谱的变化以及治疗选择的困难。IAP升高可能对机械通气患者产生不利影响，因为它与微误吸风险升高和肠屏障通畅性改变有关，因此是发生VAP的一个重要因素。此外，IAP升高会使患者的肺功能和血流动力学状况恶化，增加发生VAP的额外风险。在这种虚弱的情况下，这些患者的免疫功能受损，有发生全身感染的风险，甚至会导致多器官功能衰竭。随着微生物谱向多重耐药菌转变，ICU环境中需要综合策略来降低与IAP升高和多重耐药性VAP相关的风险。及时干预和妥善管理可以预防患者发生难以治疗的感染和危及生命的不良事件的风险。
