Clinical
Undetected IAP elevations come at
a severe cost,
Why aren’t you measuring?
If undetected, elevated IAP measurements can escalate to IAH and ACS – two costly diagnoses.
IAH and ACS are very common in the ICU and are often underdiagnosed and undertreated. IAH is prevalent in 59% of critically ill patients in the ICU and has been widely recognized as an independent risk factor for mortality.5 TraumaGuard continuously measures real-time IAP and omits immediate alerts if your patient’s IAP meet or exceed pre-determined levels, allowing your staff to promptly intervene.
Clinical FAQs
Clinical Studies
Abdominal compartment syndrome is defined as a sustained intra-abdominal pressure (IAP) > 20 mmHg that is associated with new onset of organ dysfunction or failure.ACS is a separate and distinct entity from intra-abdominal hypertension (IAH), which is defined as a sustained or repeated pathologic elevation of the IAP ~ 12 mmHg.
A common cause of IAH and ACS is fluid resuscitation. If >2 risk factors for IAH or ACS are present, a baseline measurement should be obtained, and then serial measurements performed during the patient’s critical illness.
Mixed Critical Care ACS Incidence 0.5%-8%. (6-14% trauma) (20% burn). Mortality: General Trauma Patient 12-17% vs ACS Patient 43-64%.
Link: https://www.journalacs.org/article/S1072-7515(12)01197-0/pdf
This study aimed to apply the WSACS definitions to consecutively admitted patients in a mixed medical-surgical ICU to determine the prevalence of IAH.
Prospective Observational Study: 285 consecutive patients.
IAH was found to be independently associated with mortality. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized in critically ill patients and have been shown to contribute significantly to both morbidity and mortality.
Incidence: 30% IAH @ admission + 15% IAH developed in ICU = 45% overall incidence of IAH. 8 Patient with ACS with 87.5% ACS patient mortality.
This study assessed the prevalence of IAH and its risk factors in a mixed population of intensive care patients.
A multicenter, prospective 1-day point-prevalence epidemiological study conducted in 13 ICUs of six countries with 97 patients admitted for more than 24 h to one of the ICUs during the I-day study period.
No reliable predictors could be identified therefore IAP measures are important in all mixed ICU admissions. Only the BMI was significantly associated with IAH. It seems that at least for the initial overall characterization of ICU patients, IAP should be routinely measured. Since IAP is a physiological variable that substantially fluctuates during the day it should be measured as often as possible. Prevalence of IAH 58.8% including ACS 8.2%.
Excessive fluid resuscitation, particularly with crystalloids, increases the likelihood that multisystem complications occur. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are lethal complications of excessive fluid resuscitation. Positive fluid balance has shown to increase complications and mortality specifically associated with ACS.
It is recommended that a positive fluid balance be avoided in patients at risk for developing IAH/ACS. The effects of intra-abdominal hypertension are not limited just to the intra-abdominal organs, but rather have an impact either directly or indirectly on every organ system in the body. The mortality associated with ACS has been reported as high as 80%. APP of 60 mm Hg in patients with ACS was 98% sensitive in predicting survival in a population largely composed of trauma patients.
Modern critical care paradigms emphasize rational limitations to fluid resuscitation, which may have contributed to an apparent decrease in ACS among critically ill patients. Once a critical intra-abdominal volume is reached, IAP increases exponentially with further increases in volume or as abdominal compliance decreases. Once IAH is recognized, nonsurgical steps to decrease intra-abdominal pressure (IAP) can be undertaken.
Surgical decompression with midline laparotomy is the standard ultimate treatment once ACS with organ dysfunction is established.In the face of a failure of nonsurgical methods to decrease IAP, surgical abdominal decompression and temporary maintenance of an open abdomen is considered the standard of care. Surgical decompression and an open abdomen, while potentially lifesaving, can be associated with significant morbidity.
The list of risk factors is updated and robust and one would be hard pressed to find an ICU patient that does not fit the profiles. As clinical examination is inaccurate for detecting raised IAP, IAH and ACS research and management rely upon accurate serial or continuous IAP measurements.
Amongst the recommendations, WSCACS recommends measuring IAP when any known risk factor for IAH/ACS is present in a critically ill or injured patient and efforts and/or protocols to avoid sustained IAH as compared to inattention to IAP among critically ill or injured patients.
Blaser et al report retrospectively evaluated three different risk factor-based IAP measurement practices within their institution over 7 years and 2,696 medical and surgical ICU admissions.
The identification of mean IAP within 24 hours of ICU admission is an independent predictor of mortality. Early serial IAP monitoring of patients at risk for IAH/ACS, coupled with an evidence-based multimodality management algorithm, improves patient outcome.
At least one in five ICU patients manifest elevations in IAP that have a detrimental impact on organ function and outcome. IAP measurements should be considered a routine parameter in any intensivist’s diagnostic armamentarium.
A review of Twenty-nine articles queried for “Burn” and “Abdominal Compartment Syndrome“ from The National Library of Medicine (PUBMED). One aspect of initial burn therapy is volume resuscitation. fluid administration in the early management of burns is saving lives, particularly by preventing acute kidney injury.
As a result, co-morbidities following burn injury shifted from acute kidney injury to pulmonary edema, acute respiratory distress syndrome, and secondary abdominal compartment syndrome, all possible side effects of high-volume fluid resuscitation.
Abdominal pressure monitoring is appropriate in all patients with burns that require significant volume resuscitation.
This study clarified the risk of burned patients with and without ACS, especially regarding the resuscitation fluid volume. All patients were closely monitored for increased IAP until IAP was normalized or measurements were stable no longer at risk for IAH. 17% progressed to ACS in less than 24hrs.
We found that extensively burned patients who required large volumes of fluid, especially that in excess of 300 mL/kg/24 h, show a high incidence of complication by ACS.
For the early detection of IAH, it is necessary to closely monitor the peak inspiratory pressure (PIP) and the intra-bladder pressure (IBP) should be checked if a high PIP is observed.
Expeditious Diagnosis and Laparotomy for
Patients with Acute Abdominal Compartment
Syndrome May Improve Survival
Causes of abdominal compartment syndrome (ACS) are varied and can result from both medical
and surgical diseases. Early recognition of ACS and prompt surgical treatment has been shown to
improve mortality. We hypothesize that earlier recognition of ACS and earlier involvement by
surgical specialists may improve mortality. A retrospective review between July 2010 and July 2015
was performed of adult patients who underwent decompressive laparotomy for ACS. Patients
were divided into surgical and medical intensive care units (SICU and MICU) arms. Twenty patients
were included (MICU 5 12; SICU 5 8) without significant difference between the groups.
Median time from admission to suspicion for MICU patients was 60 hours versus 13 hours for
SICU patients (P 5 0.013). Time from suspicion to surgical consult was 60 minutes versus 0 minutes,
respectively (P 5 0.003), however, time from surgical consult to intervention was not different.
Mortality rate in the MICU was 83 per cent versus 12.5 per cent in the SICU (P 5 0.005).
Patients in the SICU who developed ACS were more quickly diagnosed than those in the MICU.
These patients had a shorter time from suspicion of ACS to surgical consultation and eventual
surgical intervention, and was associated with improved survival. A multidisciplinary approach,
including early surgical consultation, for patients in whom there is a suspicion of ACS may
contribute to improved mortality.
Read More Here: https://sentinelmedtech.com/wp-content/uploads/2022/03/CompartmentSyndrome-Hazelton.pdf
Elevated Intra-Abdominal Pressure (IAP) and Intra-Abdominal Hypertension (IAH) can be found in up to 55% of critically ill patients (Sources: 1,2,3)
IAP is an important indicator that can alert practitioners to potential issues that aren’t visible with physical examination, including Abdominal Compartment Syndrome (ACS).
Read More: 🔗 Sentinel Medical Technologies – IAP Infographic 2023
Sentinel Medical Technologies (“SMT”) has developed and patented innovative technology to measure pressure in various body compartments, such as the bladder, muscle, and other potential spaces. This platform technology can be used in multiple segments within medicine. SMT has focused development efforts on The TraumaGuard Catheter System (“TG”) for IntraAbdominal Pressure (“IAP”) measurement required to detect Intra-Abdominal Hypertension (“IAH”) and life-threatening Compartment Syndrome (“ACS”).
NOVEL TRAUMAGUARD CATHETER TO MEASURE CONTINUOUS INTRA-ABDOMINAL PRESSURE
By: Phillip Jenkins, Patrick Beer, James Cranford, Gul Sachwani-Daswani, Dean Kristl, Kristoffer Wong, Lindsey Rieck, Donald Scholten, Mike Jaggi and Leo Mercer
Current techniques for measuring intraabdominal pressure (IAP) are highly variable and dependent on operator skill and method used. The goal of this study is to validate the accuracy of the TraumaGuard® catheter (TG) to continuously measure IAP via the emptied urinary bladder utilizing a novel reliable air charged system. Current methods require instillation of saline into an indwelling bladder catheter which varies from 50-100 mL depending on patient and institution.
The TraumaGuard System has been validated as the ONLY Continuous Intra-Abdominal Pressure (IAP) measurement device against four other monitoring devices in a new publication by the Journal of Clinical Medicine (JCM) MDPI.
We’re on a mission to transform critical care with innovative solutions and better alternatives. A huge thank you to the brilliant minds behind this research and to all of you for being a part of our journey.
Read the full article: In Vitro Validation of a Novel Continuous Intra-AbdominalPressure Measurement System (TraumaGuard)
Read the full article: Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion
In the 2024 article published in Perioperative Medicine, industry experts address the significant risk of acute kidney injury (AKI) in cardiac surgery patients due to intra-abdominal hypertension (IAH). AKI, linked to higher mortality, longer hospital stays, and increased costs, often stems from low abdominal perfusion pressure (APP). The paper proposes a stepwise algorithm for monitoring and managing IAH to optimize kidney function, emphasizing early intervention, continuous monitoring, and a multidisciplinary approach. Key recommendations include using balanced crystalloids, avoiding nephrotoxic substances, and setting individualized blood pressure targets.
This study supports our mission at Sentinel to enhance the standard of care by addressing unmet clinical needs, instilling technological confidence, and improving patient outcomes. Our device, TraumaGuard, the first CIAP monitor, plays a pivotal role in supporting these findings. By providing real-time data, TraumaGuard enables timely interventions, optimizing renal perfusion and patient outcomes.
A 55-year-old man with severe burns covering 70% of his body was admitted to the trauma unit, requiring urgent care. The case highlights how continuous Intra-Abdominal Pressure (IAP) monitoring with TraumaGuard helped detect life-threatening complications early, allowing for proactive interventions and better outcomes. Learn how this critical tool enhances burn care in real-time.
