Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of a repeat, international, cross-sectional survey

Background
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized as aetiologies of organ failure and mortality among a wide variety of patient populations. Since the first global survey in 2007, several surveys have been conducted. However, it remains unclear to what extent healthcare professionals in clinical practice are aware of the widely accepted definitions and recommendations proposed in the World Society of the Abdominal Compartment Syndrome (WSACS) guidelines and whether these recommendations are being applied clinically.

Methods
We conducted an international cross-sectional survey to determine the impact of the 2013 WSACS IAH/ACS Consensus Definitions and Clinical Management Guidelines on IAH/ACS clinical awareness and management. We also aimed to compare the results to the findings of the global survey conducted in 2007.

Results
The survey had 559 respondents with most respondents being physicians from Europe, and who worked in mixed intensive care units (87.3%; n = 448). The majority of respondents (73.2%) were aware of WSACS (the Abdominal Compartment Society), with a greater percentage being aware of the WSACS guidelines compared to the 2007 survey (60.2% vs. 28.4%). A considerable proportion of respondents (18%) never measure intra-abdominal pressure (IAP), with the most common reason for not measuring IAP being reliance on physical examination (39%; n = 38). Analysis of the 11 questions related to knowledge and clinical practice of IAH, ACS and WSACS consensus definitions showed an improvement from the first survey (42.7% of questions answered correctly in comparison to 48.0% in this survey, P = 0.0001). The responses to how physicians managed IAH and ACS were different to the previous survey, with diuretics being used “usually” or “frequently” (49.2%), more than inotropes (38.6%), decompressive laparotomy (37.0%), paracentesis (36.5%), and fluids/blood products (24.2%). Most respondents would perform/request a decompressive laparotomy in cases of ACS. Polycompartment syndrome was something considered by 39% (n = 218) in their daily practice. Almost two thirds of respondents (63.5%; n = 355) thought that gastrointestinal injury should be added to the Sequential Organ Failure Assessment (SOFA) score.

Conclusions
This survey shows an improvement in general awareness and knowledge regarding IAP, IAH and ACS, although the level of understanding and awareness of WSACS guidelines remains low. There appear to be some practice changes and greater awareness of the need to monitor abdominal pressures. Future initiatives should focus on education, identifying which patients should receive routine monitoring, and incorporation of IAH and ACS care into ICU bundles and protocols already in existence.