Supplement 4
Section
ICU patients
at risk for
IAH or ACS
No.,
Informal
Question
1) Whether
to measure
IAP
Overview of PICOD Structured Clinical Questions
PICOD Question
Comparator
Population
Interventions
ICU patients
IAP
measurement
No IAP
measurement
ICU patients
with IAH
2) Whether
to use APP
to guide
management
ICU patients
with IAH
IAH
management
strategies that
use APP
IAH
management
strategies that
do not
consider APP
ICU patients
with IAH
3) Whether
to keep IAP
less than 20
mmHg
ICU patients
with IAH
Strategy aimed
at keeping IAP
less than 20
mmHg
No IAP
management
strategy
ICU patients
4) Whether
to keep fluid
balance
neutral or
even
negative
ICU patients
Strategy
attempting to
obtain a neutral
or even
negative fluid
balance after
ICU day 3
A
comparatively
more liberal
fluid
management
strategy
Critically
injured
trauma
patients with
massive
hemorrhage
5) Whether
to use
damage
control
resuscitation
Critically
injured
trauma
patients with
massive
hemorrhage
No damage
control
resuscitation
ICU patients
6) Whether
ICU patients
Damage
control
resuscitation
(permissive
hypotension,
higher ratios of
PRBCs to
platelets and
plasma, and
limited
crystalloids)
Percutaneous
Usual care
Outcomes
Design
Mortality,
length of
hospital or ICU
stay, ACS,
requirement for
decompressive
laparotomy,
acute renal
failure
Mortality,
length of
hospital or ICU
stay, ACS,
requirement for
decompressive
laparotomy,
acute renal
failure
Mortality,
length of
hospital or ICU
stay, ACS,
requirement for
decompressive
laparotomy,
acute renal
failure, healthrelated quality
of life
Mortality,
length of
hospital or ICU
stay, acute renal
failure, ACS,
requirement for
decompressive
laparotomy, IAP
Mortality,
length of
hospital or ICU
stay, IAP, ACS,
requirement for
decompressive
laparotomy
RCTs,
observational
studies
Mortality,
RCTs,
RCTs,
observational
studies
RCTs,
observational
studies
RCTs,
observational
studies
RCTs,
observational
studies
with IAH or
ACS
to use a
percutaneous
drainage
catheter
with IAH or
ACS
catheter
drainage of
intraabdominal
fluid
ICU patients
with IAH
7) Whether
to treat IAH
or ACS
operatively
ICU patients
with IAH or
ACS
Decompressive
laparotomy
No
decompressive
laparotomy
Trauma or
surgery
patients
requiring
open
abdominal
management
8) Whether
to close the
fascia or
utilize a
planned
ventral
hernia
9a) Whether
to use NPWT
for
temporary
abdominal
closure
ICU patients
with open
abdominal
wounds
Fascial closure
during the
hospital stay
Use of the
planned
ventral hernia,
skin grafts,
and/or delayed
fascial closure
Trauma or
surgery
patients
requiring
open
abdominal
management
Same
ABThera open
abdomen NPT
system, KCI
VAC, or
Barker’s
vacuum pack
technique
ABThera open
abdomen NPT
system, KCI
VAC
Any other
TAC
technique
Same
ABThera open
abdomen NPT
system
KCI VAC
Trauma or
surgery
patients with
open
abdominal
wounds
Acute
components
separation
No
components
separation
9b) Whether
to use
commercial
NPWT for
temporary
abdominal
closure
9c) Choice of
commercial
NPWT for
temporary
abdominal
closure
10_ Whether
to use acute
components
separation
Barker’s
vacuum pack
technique
length of
hospital or ICU
stay,
development of
ACS or
requirement for
decompressive
laparotomy,
acute renal
failure, effect on
IAP
Mortality,
length of
hospital or ICU
stay, acute renal
failure, healthrelated quality
of life
Mortality,
primary fascial
closure, length
of hospital and
ICU stay,
abdominal
fistulae, intraabdominal
infection, IAH,
ACS
observational
studies
RCTs,
observational
studies
RCTs,
observational
studies
11) Whether
to use
bioprosthetic
meshes
Trauma or
surgery
patients with
open
abdominal
wounds
Bioprosthetic
meshes
No
bioprosthetic
meshes
Where ACS indicates abdominal compartment syndrome; APP, abdominal perfusion pressure; IAH, intra-abdominal
hypertension; IAP, intra-abdominal pressure; ICU, intensive care unit; KCI, Kinetic Concepts Incorporated; NPT,
negative pressure therapy; NPWT, negative pressure wound therapy; PICOD, Patient, Intervention, Comparator,
Outcome, Design; RCTs, randomized controlled trials; VAC, vacuum-assisted closure.