Abdominal perfusion pressure: clinical implications and as an alternative to discontinuing vasopressors

The maintenance of adequate organ perfusion depends fundamentally on mean arterial pressure (MAP) and the proper functioning of the cardiovascular system. Intra-abdominal pressure (IAP) acquires a new point of clinical relevance when the patient requires vasopressor support, given that abdominal perfusion pressure (APP) (defined as the difference between MAP and IAP) is an integral parameter in the evaluation of abdominal organ perfusion and may represent a guide for the increase or decrease of these agents. It has been demonstrated that APP is superior for assessing organ perfusion and overall survival in critically ill patients compared to MAP or IAP in isolation; likewise, its impact is undeniable, particularly in patients with intra-abdominal hypertension. In the anesthetic and critical care setting, there are scenarios in which an increase in IAP may be promoted (surgical procedures, laparoscopic interventions, fluid overload, sepsis, obesity, abdominal trauma, among others), and in response to this increase, significant hemodynamic and ventilatory alterations may be generated; therefore, in patients requiring vasopressors, knowledge of APP constitutes an additional tool in their management. Furthermore, it may guide the adjustment (initiation, titration, or withdrawal) of these agents based on abdominal perfusion and systemic response. The objective of this article is to raise awareness within the medical community about the importance of APP and its use as a tool in resuscitation strategies, as well as its role in the weaning of vasopressors.