Should intra-abdominal pressure monitoring occur in severe sepsis?
Though it is clear that severe sepsis and septic shock are major risk factors for IAH/ACS, the data evaluating interventional therapy to improve outcomes in sepsis are scarce. However, the preponderance of circumstantial evidence suggests it should be considered. On initial presentation septic shock patients are volume depleted and will be unlikely to have IAH/ACS. However, as EGDT is implemented and patients are fluid resuscitated their intra-vascular and interstitial fluids are in a state of rapid fluctuation creating an ever-changing hemodynamic picture. Because end-expiratory CVP is the primary measurement used in EGDT to assess fluid status the accuracy of CVP is critical to ensure adequate but not over-zealous fluid administration. Unfortunately, end-expiratory CVP overestimates fluid status in patients suffering from IAH.15 Furthermore, IAH causes splanchnic hypoperfusion long before lactate elevation or ScvO2 changes are apparent and may further compromise renal function indepe
