International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome
Authors: Nasa Prashant , Wise Robert D. , Smit Marije , Acosta Stefan , D’Amours Scott , Beaubien–Souligny William , Bodnar Zsolt , Coccolini Federico , Dangayach Neha S. , Dabrowski Wojciech , Duchesne Juan , Ejike Janeth C. , Augustin Goran , De Keulenaer Bart , Kirkpatrick Andrew W. , Khanna Ashish K. , Kimball Edward , Koratala Abhilash , Lee Rosemary K. , Leppaniemi Ari , Lerma Edgar V. , Marmolejo Valerie , Meraz–Munoz Alejando , Myatra Sheila N. , Niven Daniel , Olvera Claudia , Ordoñez Carlos , Petro Clayton , Pereira Bruno M. , Ronco Claudio , Regli Adrian , Roberts Derek J. , Rola Philippe , Rosen Michael , Shrestha Gentle S. , Sugrue Michael , Velez Juan Carlos Q. , Wald Ron , De Waele Jan , Reintam Blaser Annika , Malbrain Manu L. N. G. 
Published: November 2024

Abstract
Background
The Abdominal Compartment Society (WSACS) established consensus definitions and recommendations for the management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in 2006, and they were last updated in 2013. The WSACS conducted an international survey between 2022 and 2023 to seek the agreement of healthcare practitioners (HCPs) worldwide on current and new candidate statements that may be used for future guidelines.

Methods
A self-administered, online cross-sectional survey was conducted under the auspices of the WSACS to assess the level of agreement among HCPs over current and new candidate statements. The survey, distributed electronically worldwide, collected agreement or disagreement with statements on the measurement of intra-abdominal pressure (IAP), pathophysiology, definitions, and management of IAH/ACS. Statistical analysis assessed agreement levels, expressed in percentages, on statements among respondents, and comparisons between groups were performed according to the respondent’s education status, base specialty, duration of work experience, role (intensivist vs non-intensivist) and involvement in previous guidelines. Agreement was considered to be reached when 80% or more of the respondents agreed with a particular statement.

Results
A total of 1042 respondents from 102 countries, predominantly physicians (73%), of whom 48% were intensivists, participated. Only 59% of HCPs were aware of the 2013 WSACS guidelines, and 41% incorporated them into practice. Despite agreement in most statements, significant variability existed. Notably, agreement was not reached on four new candidate statements: “normal intra-abdominal pressure (IAP) is 10 mmHg in critically ill adults” (77%), “clinical assessment and estimation of IAP is inaccurate” (65.2%), “intragastric can be an alternative to the intravesical route for IAP measurement” (70.4%), and “measurement of IAP should be repeated in the resting position after measurement in a supine position” (71.9%). The survey elucidated nuances in clinical practice and highlighted areas for further education and standardization.

Conclusion
More than ten years after the last published guidelines, this worldwide cross-sectional survey collected feedback and evaluated the level of agreement with current recommendations and new candidate statements. This will inform the consensus process for future guideline development.