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Intra-abdominal pressure (IAP) is defined as the steady-state pressure confined within the abdominal cavity (Malbrain and others 2006, Sereda 2007). The abdomen can be considered a closed box. The elasticity of the walls and the character of its contents determine the pressure within the abdomen (Schachtrupp and others 2003, Malbrain and others 2006). IAP increases during inspiration and decreases during expiration, and can be altered by intra-abdominal and extra-abdominal causes (Cheatham and Safcsak 1998, Mayberry 1999, Ivatury and others 2001, Hong and others 2002, Balogh and others 2004, Sugrue 2005). Intra-abdominal causes include bladder rupture, gastric dilatation-volvulus, ileus, pancreatitis, visceral oedema (SIRS, fluid overload), peritonitis, presence of ascites, blood, tumours, gravid uterus and recent abdominal surgery, among others. Extra-abdominal causes, reported in human beings, are related to pain, mechanical ventilation, fluid therapy overload, burns, sepsis, pneumonia and thoracic trauma, among others (Ivatury and others 2001, Malbrain and others 2006).
In human beings, intra-abdominal hypertension (IAH) is defined as a sustained or repeated pathological elevation in IAP ≥12 mm Hg causing occult ischaemia without organ failure (Malbrain and Jones 2006). Abdominal compartment syndrome (ACS) occurs when IAH causes adverse effects on physiological function, and has been associated with an increase in morbidity and mortality in critical ill patients (Kashtan and others 1981, Robotham and others 1985, Cullen and others 1989, Chang and others 1998, Drellich 2000). Pathophysiologic effects of IAH are well documented in both human beings (Barnes and others 1985, Robotham and others 1985, Sugerman and others 1997) and dogs (Drellich 2000), and involve the cardiovascular, respiratory, renal, gastrointestinal and nervous systems. Abdominal perfusion pressure (APP), calculated by subtracting IAP from mean arterial blood pressure (MAP) (APP = MAP—IAP), has been proposed as an accurate predictor of visceral organ perfusion, and a potential endpoint for resuscitation in human beings (Cheatham and Safcsak …