Medical treatment options to reduce IAP

 Improve abdominal wall compliance

• Sedation & analgesia

• Neuromuscular blockade

• Avoid head of bed > 30 degrees

Evacuate intra-luminal contents

• Nasogastric decompression

• Rectal decompression

• Gastro-/colo-prokinetic agents

Evacuate abdominal fluid collections

• Paracentesis

• Percutaneous drainage

Correct positive fluid balance

• Avoid excessive fluid resuscitation

• Diuretics

• Colloids / hypertonic fluids

• Hemodialysis / ultrafiltration

Organ Support

• Maintain APP > 60 mmHg with vasopressors

• Optimize ventilation, alveolar recruitment

• Use transmural (tm) airway pressures

  • Pplattm = Pplat - IAP

• Consider using volumetric preload indices

• If using PAOP/CVP, use transmural pressures

  • PAOPtm = PAOP - 0.5 * IAP

  • CVPtm = CVP - 0.5 * IAP