Table 5.

Final 2013 WSACS consensus management statements

Recommendations
1.	We recommend measuring IAP when any known risk factor for IAH/ACS is present in a critically ill or injured patient [GRADE 1C]
2.	Studies should adopt the trans-bladder technique as the standard IAP measurement technique [not GRADED]
3.	We recommend use of protocolized monitoring and management of IAP versus not [GRADE 1C]
4.	We recommend efforts and/or protocols to avoid sustained IAH as compared to inattention to IAP among critically ill or injured patients [GRADE 1C]
5.	We recommend decompressive laparotomy in cases of overt ACS compared to strategies that do not use decompressive laparotomy in critically ill adults with ACS [GRADE 1D]
6.	We recommend that among ICU patients with open abdominal wounds, conscious and/or protocolized efforts be made to obtain an early or at least same-hospital-stay abdominal fascial closure [GRADE 1D]
7.	We recommend that among critically ill/injured patients with open abdominal wounds, strategies utilizing negative pressure wound therapy should be used versus not [GRADE 1C]
Suggestions
1.	We suggest that clinicians ensure that critically ill or injured patients receive optimal pain and anxiety relief [GRADE 2D]
2.	We suggest brief trials of neuromuscular blockade as a temporizing measure in the treatment of IAH/ACS [GRADE 2D]
3.	We suggest that the potential contribution of body position to elevated IAP be considered among patients with, or at risk of, IAH or ACS [GRADE 2D]
4.	We suggest liberal use of enteral decompression with nasogastric or rectal tubes when the stomach or colon are dilated in the presence of IAH/ACS [GRADE 1D]
5.	We suggest that neostigmine be used for the treatment of established colonic ileus not responding to other simple measures and associated with IAH [GRADE 2D]
6.	We suggest using a protocol to try and avoid a positive cumulative fluid balance in the critically ill or injured patient with, or at risk of, IAH/ACS after the acute resuscitation has been completed and the inciting issues have been addressed [GRADE 2C]
7.	We suggest use of an enhanced ratio of plasma/packed red blood cells for resuscitation of massive hemorrhage versus low or no attention to plasma/packed red blood cell ratios [GRADE 2D]
8.	We suggest use of PCD to remove fluid (in the setting of obvious intraperitoneal fluid) in those with IAH/ACS when this is technically possible compared to doing nothing [GRADE 2C]. We also suggest using PCD to remove fluid (in the setting of obvious intraperitoneal fluid) in those with IAH/ACS when this is technically possible compared to immediate decompressive laparotomy as this may alleviate the need for decompressive laparotomy [GRADE 2D]
9.	We suggest that patients undergoing laparotomy for trauma suffering from physiologic exhaustion be treated with the prophylactic use of the open abdomen versus intraoperative abdominal fascial closure and expectant IAP management [GRADE 2D]
10.	We suggest not to routinely utilize the open abdomen for patients with severe intraperitoneal contamination undergoing emergency laparotomy for intra-abdominal sepsis unless IAH is a specific concern [GRADE 2B]
11.	We suggest that bioprosthetic meshes should not be routinely used in the early closure of the open abdomen compared to alternative strategies [GRADE 2D]
No recommendations
1.	We could make no recommendation regarding use of abdominal perfusion pressure in the resuscitation or management of the critically ill or injured
2.	We could make no recommendation regarding use of diuretics to mobilize fluids in hemodynamically stable patients with IAH after the acute resuscitation has been completed and the inciting issues have been addressed
3.	We could make no recommendation regarding the use of renal replacement therapies to mobilize fluid in hemodynamically stable patients with IAH after the acute resuscitation has been completed and the inciting issues have been addressed
4.	We could make no recommendation regarding the administration of albumin versus not, to mobilize fluid in hemodynamically stable patients with IAH after acute resuscitation has been completed and the inciting issues have been addressed
5.	We could make no recommendation regarding the prophylactic use of the open abdomen in non-trauma acute care surgery patients with physiologic exhaustion versus intraoperative abdominal fascial closure and expectant IAP management
6.	We could make no recommendation regarding use of an acute component separation technique versus not to facilitate earlier abdominal fascial closure

ACS abdominal compartment syndrome, IAP intra-abdominal pressure, IAH intra-abdominal hypertension, PCD percutaneous catheter drainage