Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review

Rita Jacobs, Robert Wise, Ivan Myatchin, Domien Vanhonacker, Andrea Minini, Michaël Maurits M Mekeirele, Andrew W Kirkpatrick, Bruno Pereira, Michael Sugrue, Bart De Keulenaer, Zsolt Bodnar, Stefan Acosta, Janeth C Ejike, Salar Tayebi, Johan Stiens, Colin Cordemans, Niels van Regenmortel, Paul W G Elbers, Xavier Monnet, Adrian WongWojciech Dabrowski, Philippe G. Jorens, Jan De Waele, Derek J Roberts, Edward J Kimball, Annika Reintam Blaser, Manu Malbrain

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Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS). Methods: We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH. Results: We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality. Conclusions: Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial.
Original languageEnglish
Article number1390
Number of pages39
Issue number9
Publication statusPublished - 6 Sep 2022

Bibliographical note

Funding Information:
No funding was provided except for support by WSACS (www.wsacs.org (accessed on: 26 May 2022)) and University Hospital Antwerp to cover the Open Access fee.

Funding Information:
ARB received speaker’s fees from Fresenius Kabi and Nestlé, and her institution (University of Tartu) received a study grant from Fresenius Kabi. AWK is the Principal Investigator of the COOL Trial ( https://clinicaltrials.gov/ct2/show/NCT03163095 (accessed on: 26 May 2022)), which has received unrestricted funding from the Abdominal Compartment Society and the Acelity Corp. AWK has also consulted for Zoll Medical, the Innovative Trauma Care, and the SAM Medical Corporations. MLNGM is a member of the medical advisory Board of Pulsion Medical Systems (now fully integrated in Getinge, Solna, Sweden) and Serenno Medical (Tel Aviv, Israel), consults for Baxter, Maltron, ConvaTec, Acelity, Spiegelberg and Holtech Medical. He is co-founder and President of the International Fluid Academy (IFA). He is co-founder, past-president and current treasurer of the Abdominal Compartment Society, formerly known as the World Society of Abdominal Compartment Syndrome ( https://www.wsacs.org/ (accessed on: 26 May 2022)). XM is a member of the Medical Advisory Board of Pulsion Medical Systems. He made paid lectures for Cheetah Medical. MS had undertaken consulting with Smith and Nephew, Acelity and Novus Scientific All other authors declare that they have no competing interests in relation to the content published in this manuscript.

Publisher Copyright:
© 2022 by the authors.

Copyright 2022 Elsevier B.V., All rights reserved.


  • fluid therapy
  • abdominal hypertension
  • abdominal compartment syndrome
  • open abdomen
  • crystalloids
  • colloids
  • hypertonic
  • resuscitation
  • maintenance
  • sepsis


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