A standardized approach to intra-abdominal pressure
measurement in critically ill pediatric patients
Lauren Walker RN, BSN, CCRN & Hartley Wenger RN, BSN, CCRN
Georgetown University
Background
Methods
Conclusion
Intra-abdominal hypertension (IAH) is a potentially lifethreatening condition that if left untreated can lead to
abdominal compartment syndrome (ACS),
compromising cardiopulmonary and renal function and
ultimately resulting in death. The World Society of the
Abdominal Compartment Syndrome (WSACS) has
issued evidenced-based treatment guidelines and
recommendations for the diagnosis and management
of IAH and ACS in critically ill patients. Early
identification and treatment of IAH is essential to
preserving adequate organ function and reducing
morbidity and mortality; however, intra-abdominal
pressure (IAP) is not routinely measured. As a result,
IAH often goes undiagnosed. The use of a
standardized method of measuring IAP on patients
who are at risk for developing IAH can help reduce the
incidence of IAH and ACS and complications
associated with each.
A needs assessment survey was distributed to all staff
nurses in the Pediatric Intensive Care Unit (PICU).
After careful review of the survey results, it was
evident that there was an overall knowledge deficit
regarding Intra-abdominal pressure. An educational
presentation was implemented and a policy written.
IAP measurement procedure and return demonstration
as well as a post-assessment competency were
completed by the staff nurses. Once these
interventions were implemented, all staff nurses were
found to be competent in IAP measurement procedure.
Evidence-based research has determined that early
identification and treatment of IAH is essential to
preserving adequate organ function and reducing
morbidity and mortality. Despite compelling data, IAP
measurement is not routinely practiced in the PICU.
Instead, clinicians use abdominal girth as a way of
assessing IAH. This form of measurement is
unreliable in identifying IAH and ACS. The “gold
standard” for measuring IAP is the intravesical
technique. Through education of PICU staff nurses
on the importance of measuring IAP, the proper
measurement technique, and appropriate
management of IAH and ACS, the knowledge gap
surrounding IAP measurement has been closed. By
adopting the evidence-based guideline
recommendations for the management and treatment
of IAH and ACS and by incorporating these into both
our staff education and PICU policy, morbidity and
mortality associated with these conditions will be
reduced and patient outcomes will improve.
Objectives
Despite treating a wide variety of patients at risk for
developing IAH, IAP is not routinely measured in our
critically ill pediatric patients. When IAP
measurements have been taken, it has only been
when clinical signs of deterioration are evident.
Unfortunately, this is often too late. The purpose of
this project is to:
• Highlight the importance of measuring intraabdominal pressure in critically ill pediatric patients
• Identify patients at risk for developing IAH
• Ensure that the WSACS approved, standardized
measurement technique is utilized for measuring
IAP in the pediatric intensive care unit
Results
 The needs assessment demonstrated a knowledge
deficit regarding IAP measurement.
 The IAP measurement educational presentation
implemented reduced the knowledge gap and
adequately prepared all staff nurses to accurately
identify patients at risk for developing IAH, measure
IAP, and treat IAH and ACS.
References
Beck, R., Halberthal, M., Zonis, Z., Shoshani, G., Hayari, L., et al.
(2001). Abdominal compartment syndrome in children. Pediatric
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Cheatham, M. L. (2008). Are children really small adults? Critical Care
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Ejike, J. C., Bahjri, K., & Mathur, M. (2008). What is the normal intraabdominal pressure in critically ill children and how should we
measure it? Critical Care Medicine, 36(7), 2157-2162
Malbrain, M., De laet, I., Van Regenmortel, N., Schoonheydt, K., &
Dits, H. (2009). Can the abdominal perimeter be used as an
accurate estimation of intra-abdominal pressure? Critical Care
Medicine, 37(1), 316-319. doi:10.I007/s00268-002-641 i-8
The World Society of Abdominal Compartment Syndrome. (2009).
WSACS Consensus Guidelines Summary. Retrieved September 1,
2011, from http://www.wsacs.org/consensus_summary.php