Measurement of intra-abdominal pressure is used to identify children at risk of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). IAH & ACS are most likely to occur in the setting of major fluid resuscitation, severe gut oedema, intra-peritoneal or retroperitoneal bleeding, or ascites. Patient groups may include trauma, burns, septic shock, post abdominal surgery. IAH & ACS can cause significant morbidity and mortality due to reduced venous return and cardiac output, and altered respiratory mechanics. This results in end organ dysfunction; renal failure, impaired hepatic blood flow, respiratory failure, poor splanchnic perfusion and increased intracranial pressure are potential problems. Early recognition and treatment of IAH & ACS has been shown to significantly improve morbidity and mortality.
The aim of this guideline is to outline the management principles related to intra-abdominal pressure monitoring within the Paediatric Intensive Care Unit at the Royal Children's Hospital.
Bladder Pressure: reflects the intra-abdominal pressure and is measured via the indwelling urinary catheter. It is expressed in mmHg.
Intra-abdominal Pressure (IAP): is the pressure within the abdominal cavity. Normal IAP in a well child is 0 mmHg and in a child on positive pressure ventilation is 1 - 8 mmHg.
Intra-abdominal hypertension (IAH): is defined as an IAP greater than 12mmHg.
Abdominal compartment syndrome (ACS): is defined as an IAP >20mmHg and the onset of new organ failure.
Abdominal perfusion pressure (APP): APP = Mean Arterial Pressure (MAP) - IAP. In adults keeping this > 50-60mmHg significantly improves morbidity & mortality. The appropriate APP for children is unknown, but will be less than the adult level due to a lower MAP.
Infection of the bladder is a complication of this procedure. Symptoms vary depending on the age of the child but include:
Urine culture and sensitivity is the gold standard for diagnosis if an infection is suspected.
Please remember to read the disclaimer.
The development of this clinical guideline was coordinated by Janine Evans, Rosella - PICU. Approved by the Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive Director Nursing Services. This updated version published March 2012 (originally published 2007).
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