Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review
 
Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review ■
 
Rita Jacobs, Rita Jacobs, Rita Jacobs, Robert Wise, Robert Wise, Robert Wise, Ivan Myatchin, Ivan Myatchin, Ivan Myatchin, Domien Vanhonacker, Domien Vanhonacker, Domien Vanhonacker, Andrea Minini, Andrea Minini, Andrea Minini, Michaël Maurits M Mekeirele, Michaël Maurits M Mekeirele, Michaël Maurits M Mekeirele, Andrew W Kirkpatrick, Andrew W Kirkpatrick, Andrew W Kirkpatrick, Bruno Pereira, Bruno Pereira, Bruno Pereira, Michael Sugrue, Michael Sugrue, Michael Sugrue, Bart De Keulenaer, Bart De Keulenaer, Bart De Keulenaer, Zsolt Bodnar, Zsolt Bodnar, Zsolt Bodnar, Stefan Acosta, Stefan Acosta, Stefan Acosta, Janeth C Ejike, Janeth C Ejike, Janeth C Ejike, , , , Johan Stiens, Johan Stiens, Johan Stiens, Colin Cordemans, Colin Cordemans, Colin Cordemans, Niels van Regenmortel, Niels van Regenmortel, Niels van Regenmortel, Paul W G Elbers, Paul W G Elbers, Paul W G Elbers, Xavier Monnet, Xavier Monnet, Xavier Monnet, Adrian Wong, Adrian Wong, Adrian Wong, Wojciech Dabrowski, Wojciech Dabrowski, Wojciech Dabrowski, Philippe G. Jorens, Philippe G. Jorens, Philippe G. Jorens, Jan De Waele, Jan De Waele, Jan De Waele, Derek J Roberts, Derek J Roberts, Derek J Roberts, Edward J Kimball, Edward J Kimball, Edward J Kimball, Annika Reintam Blaser, Annika Reintam Blaser, Annika Reintam Blaser, Manu Malbrain, Manu Malbrain, Manu Malbrain
 
Abstract ■

Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS). Methods: We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH. Results: We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality. Conclusions: Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial.