Background and aim Hitherto, neither evidence-based definitions nor age-related recommendations existed on the diagnosis and treatment of Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS) in childhood. Following their 7th World Congress 2011 in Orlando (Florida), the World Society of the Abdominal compartment ayndrome (www. WSACS.org) instructed a paediatric expert committee to develop appropriate guidelines.
Methods Based on a systematic database search relevant literature was identified related to neonatal and paediatric IAH/ACS. Using a modified Delphi methodology according to the GRADE model (A to D), all papers were checked with respect to their validity and evidence. Afterwards, paediatric consensus definitions and recommendations were framed.
Results Results were published in intensive care medicine together with the revised 2013 consensus guidelines for adults (ICM 2013; 39(7):1190–206). Besides general definitions, risk factors and critical IAP thresholds (IAP: intra-abdominal pressure) recommendations were formulated concerning a standardised IAH and ACS monitoring as well as a rational therapeutic management (including medical, interventional and surgical therapy options). While in adults an IAP of 12 mmHg is regarded as dangerous, an IAP of at the latest 10 mmHg must be looked upon as IAH in children. The additional appearance of a new or aggravated organ dysfunction marks the transition into an ACS, whose diagnosis should result in the quickest possible abdominal decompression. If a decompressing laparotomy does not suffice for a durable IAP diminution itself, a prophylactic open-abdomen concept must be considered (syn.: laparostomy). The concept of abdominal perfusion pressure (APD = MAP -IAP) can facilitate the assessment of the pathogenetic influence of IAH in daily clinical practice.
Discussion In the context of former surveys, paediatric intensivists often justified their widespread uncertainty and restraint with respect to regular IAP measurements and timely introduction of invasive therapy options (if indicated) with the lack of age-related guidelines and definitions. This first publication of paediatric IAP limiting values and management recommendations therefore represents an essential treatment progress and a therapeutic decision support, which should submit a significant reduction in morbidity and mortality of IAH and ACS in children and adolescents.
Conclusion Since the evidence of the underlying literature has to be classified on average as low, well-designed multicenter studies are urgently needed to enable a critical reevaluation of these consensus results.