Intra-abdominal hypertension is a common serious complication in critically ill patients. Intra-abdominal pressure (IAP) measurement is the only reliable method of detecting and managing IAP. Various factors influence the knowledge, attitude and practice of IAP measurement.

To assess the knowledge, attitude and practice of IAP measurement among ICU nurses and to identify the factors affecting the knowledge, attitude and practice.

A multi-centre cross-sectional survey was conducted in 38 hospitals in Guangdong province, China, from March to June 2024.

A total of 1254 valid questionnaires were collected. The median scores of knowledge were 8.0, with an interquartile range of 7.0-8.0. The median scores of attitude were 23.0, with an interquartile range of 21.0-25.0. The median scores of practice were 41.0, with an interquartile range of 36.0-45.0. There was a positive and significant relationship between knowledge, attitude and practice. Multiple linear regression analysis indicated that ICU type (95%CI = -0.469 to -0.163, p = .000), education level (95%CI = 0.024-0.332, p = .024), monthly income (95%CI = 0.054-0.227, p = .002), attitude (95%CI = 0.038-0.090, p = .000) and practice (95%CI = 0.033-0.055, p = .000) independently affected the knowledge; age (95%CI = 0.068-0.815, p = .021), clinical instructor (95%CI = 0.145-0.822, p = .005), head nurse (95%CI = 0.006-1.409, p = .048), knowledge (95%CI = 0.174-0.411, p = .000) and practice (95%CI = 0.077-0.123, p = .000) independently affected the attitude; and age (95%CI = -0.956 to -0.031, p = .036), knowledge (95%CI = 0.871-1.416, p = .000) and attitude (95%CI = 0.446-0.702, p = .000) independently affected the practice.

Although the knowledge, attitude and practice of IAP measurement among ICU nurses are acceptable, there is still room for improvement in knowledge and practice. Nursing managers should strengthen management, provide more learning resources and training to meet nurses' needs about IAP measurement, so as to further improve the early recognition and management of increased IAP.

The data highlight the knowledge, attitude and practice and determinant factors of IAP measurement among ICU nurses and will help to make management protocols in the future. Nursing educators and administrators are recommended to provide guidance, training and support to further improve knowledge and practice of IAP measurement among the ICU nurses.

To evaluate and summarize the available evidence on the prevention and management of nasogastric aspiration in critically ill patients to inform the development of evidence-based clinical practice.

This study was an evidence summary according to the evidence summary reporting standard of the Fudan University Center for Evidence-Based Nursing.

According to the '6S' model of evidence resources, evidence on the prevention and management of aspiration in critically ill patients on nasogastric feeding was retrieved, including clinical decision-making, best practices, guidelines, evidence summaries, expert consensus and systematic evaluations.

UpToDate, BMJ Best Practice, JBI, National Guideline Clearing-house, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Yi Mai tong Guidelines Network, the Cochrane Library, PubMed, Web of Science, Embase, OVID, Sinomed, CNKI, Wan Fang database. The search period was from January 2013 to June 2023.

We included a total of 30 high-quality articles and summarized 36 pieces of evidence from them. These pieces of evidence covered 11 dimensions of multidisciplinary management, aspiration risk assessment, tube location, nutritional infusion management, position management, airway management, and oral hygiene. The level of evidence in the study was predominantly level 1 and level 5, with 27 pieces of evidence recommended as 'strong' and 9 pieces of evidence recommended as 'weak'.

This study summarizes 36 pieces of evidence on preventing and managing aspiration in critically ill patients with nasogastric feeding. But the characteristics of hospitals should be considered in the application of future evidence.

Aspiration is the most serious complication during nasogastric feeding, which seriously affects the prognosis of patients. Preventing and managing aspiration in nasogastric patients has proven to be a challenging clinical problem. This study summarized 36 pieces of best evidence in 11 dimensions, including multidisciplinary team, assessment and identification, line position, feeding management, and so on. The implementation of these evidences is conducive to standardizing the operation behaviour of nasogastric feeding in clinical medical staff and reducing the occurrence of aspiration.

This research followed the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing.

The registration number is 'ES20221368'.

This is a pilot study to determine the feasibility of a multicentre stepped wedge cluster randomized trial of implementing the 2013 World Society of the Intraabdominal Compartment Syndrome (WSACS) guidelines as an intervention to treat intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in critically ill patients.

Single-centre before-and-after trial, with an observation / baseline period of 3 months followed by a 9-month intervention period.

A 35 bed medical-surgical-trauma intensive care unit in a tertiary level, Canadian hospital.

Recruitment from consecutively admitted adult intensive care unit patients.

In the intervention period, treatment teams were prompted to implement WSACS interventions in all patients diagnosed with IAH.

129 patients were recruited, 59 during the observation period and 70 during the intervention period. Only 17.0% and 12.9%, respectively, met diagnostic criteria for IAH. Many recruited patients did not have intraabdominal pressures measured regularly per study protocol. There was no difference in ICU mortality for patients in either cohort or between those with and without IAH.

The incidence of IAH in our patient population has decreased significantly since 2015. This is likely due to a significant change in routine care of critically ill patients, especially with respect to judicious goal-directed fluid resuscitation. Patient recruitment and protocol adherence in this study were low, exacerbated by other staffing and logistical pressures during the study period. We conclude that a larger multicentre trial is unlikely to yield evidence of a detectable treatment effect.

Continuing studies related to Abdominal Compartment Syndrome (ACS) is imperative in terms of its significant effect on morbidity and mortality rates. To establish bibliometric analysis as a comprehensive review of ACS literature. The process encompasses many phases, such as delineating search terms, beginning and refining search results, creating preliminary statistics from the data, and performing data evaluation. Scopus database was selected as the primary source, and VOSviewer software was used to visualize author networks, country affiliations, journal affiliations, and keyword associations. The analysis was conducted on January 16th, 2023, and yielded a total of 855 documents spanning the period from 1993 to 2022. Studies on ACS showed an annual increase, but it has not yet reached a mature stage. United States leads the world in terms of the highest number of publications, h-index, citations, and the involvement of renowned authors and organizations. Through an analysis of less frequently used keywords, this study identified potential themes for future investigation, including histopathology, biological markers, interleukin 6, alanine aminotransferase, early diagnosis, scoring systems, the severity of illness indices, clinical practices, patient monitoring, preoperative evaluations, minimally invasive surgery, inter-method comparisons, multicenter studies, follow-up investigations, systematic reviews, and meta-analyses. While publications in ACS journals are crucial, they alone are not exhaustive, necessitating further research.

Introduction: Intra-abdominal pressure (IAP) has been recognized as an important vital sign in critically ill patients. Due to the high prevalence and incidence of intra-abdominal hypertension in surgical (trauma, burns, cardiac) and medical (sepsis, liver cirrhosis, acute kidney injury) patients, continuous IAP (CIAP) monitoring has been proposed. This research was aimed at validating a new CIAP monitoring device, the TraumaGuard from Sentinel Medical Technologies, against the gold standard (height of a water column) in an in vitro setting and performing a comparative analysis among different CIAP measurement technologies (including two intra-gastric and two intra-bladder measurement devices). A technical and clinical guideline addressing the strengths and weaknesses of each device is provided as well. Methods: Five different CIAP measurement devices (two intra-gastric and three intra-vesical), including the former CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, were validated against the gold standard water column pressure in a bench-top abdominal phantom. The impacts of body temperature and bladder fill volume (for the intra-vesical methods) were evaluated for each system. Subsequently, 48 h of continuous monitoring (n = 2880) on top of intermittent IAP (n = 300) readings were captured for each device. Using Pearson's and Lin's correlations, concordance, and Bland and Altman analyses, the accuracy, precision, percentage error, correlation and concordance coefficients, bias, and limits of agreement were calculated for all the different devices. We also performed error grid analysis on the CIAP measurements to provide an overview of the involved risk level due to wrong IAP measurements and calculated the area under the curve and time above a certain IAP threshold. Lastly, the robustness of each system in tracking the dynamic variations of the raw IAP signal due to respirations and heartbeats was evaluated as well. Results: The TraumaGuard was the only technology able to measure the IAP with an empty artificial bladder. No important temperature dependency was observed for the investigated devices except for the Spiegelberg, which displayed higher IAP values when the temperature was increased, but this could be adjusted through recalibration. All the studied devices showed excellent ability for IAP monitoring, although the intra-vesical IAP measurements seem more reliable. In general, the TraumaGuard, Accuryn, and Serenno showed better accuracy compared to intra-gastric measurement devices. On average, biases of +0.71, +0.93, +0.29, +0.25, and -0.06 mm Hg were observed for the CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, respectively. All of the equipment showed percentage errors smaller than 25%. Regarding the correlation and concordance coefficients, the Serenno and TraumaGuard showed the best results (R2 = 0.98, p = 0.001, concordance coefficient of 99.5%). Error grid analysis based on the Abdominal Compartment Society guidelines showed a very low associated risk level of inappropriate treatment strategies due to erroneous IAP measurements. Regarding the dynamic tracings of the raw IAP signal, all the systems can track respiratory variations and derived parameters; however, the CiMON was slightly superior compared to the other technologies. Conclusions: According to the research guidelines of the Abdominal Compartment Society (WSACS), this in vitro study shows that the TraumaGuard can be used interchangeably with the gold standard for measuring continuous IAP, even in an empty artificial bladder. Confirmation studies with the TraumaGuard in animals and humans are warranted to further validate these findings.

Intra-abdominal hypertension (IAH) has been acknowledged as an important contributor to organ dysfunction in critically ill patients, both in surgical and medical conditions. As our understanding of the pathophysiology evolves, risk factors are better recognized, preventive measures can now be implemented and therapeutic interventions tailored to the physiology of the patient. In the current review, we want to highlight developing insights in the epidemiology and treatment of patients with IAH and ACS.

The impact of IAH and ACS on kidney function and other outcomes continues to draw attention in recent studies. New methods for IAP measurement are under development, and the search for biomarkers to detect IAH or ACS continues. In conditions wherein IAH and ACS are common, recent studies allow better prevention and treatment of these conditions, based on the contemporary ICU management consisting of IAP measurement, judicious fluid resuscitation and decompressive laparotomy where necessary. Surgical treatment options including open abdomen therapy continue to be improved with demonstrable impact on outcomes.

In this manuscript, we provide an overview of recent insights and developments in the epidemiology, monitoring and treatment of patients with IAH and/or ACS.

The purpose of this Technologic Analysis is to review devices designed to measure intra-abdominal pressure (IAP); these devices are used to detect intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).

Published literature focusing on devices designed to measure IAP was reviewed, comparing the options available and outlining recommendations for appropriate use. Safety information regarding IAP measurement devices was derived from the Manufacturer and User Facility Device Experience (MAUDE) database.

Intra-abdominal hypertension is prevalent among critically ill patients of all ages and is linked to adverse consequences, such as abdominal compartment syndrome. The condition is often unrecognized due to the lack of overt clinical symptoms, supporting the need for devices to accurately measure IAP. Commercially available devices measure IAP indirectly, typically via the bladder or stomach. Additional research is needed to demonstrate the benefits of routine screening, further define risk factors for IAH/ACS development, and evaluate the impact of measures to reduce IAP in an effort to improve patient outcomes.

Abdominal compartment syndrome (ACS) develops when organ failure arises secondary to an increase in intraabdominal pressure. The abdominal pressure is determined by multiple factors such as blood pressure, abdominal compliance, and other factors that exert a constant pressure within the abdominal cavity. Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction. Among surgical and trauma patients, aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS. Other conditions that have also been identified as risk factors are ascites, hemoperitoneum, bowel distention, and large tumors. All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension (IAH). Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery, abdominal aortic aneurysm repair, and liver transplantation among others. Close monitoring of organ function and intra-abdominal pressure (IAP) allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP. Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction. There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.