Critically ill patients with increased intra-abdominal pressure (IAP) and multidrug-resistant (MDR) ventilator-associated pneumonia (VAP) are considered a challenging patient population in every ICU setting. Patients with MDR VAP tend to present differently in comparison with non-MDR VAP patients. Most cases are late-onset VAP, with prior use of antibiotics.

In many patients, the initial therapy was not optimal. These patients stay longer in the hospital and present higher mortality rates. Understanding the pathophysiological interplay between increased IAP and VAP is essential for effective management.

After reviewing data following personal communication with authors from a previous study, there is an initial insight that there is a potential positive correlation between elevated IAP and incidence of MDR VAP.

Increased IAP and IAH could cause VAP through translocation and gastroesophageal reflux.

Translocation is the result of reduced APP, decreased visceral blood flow, and disruption of the gastrointestinal barrier.

While elevated IAP and intra-abdominal hypertension (IAH) could cause organ dysfunction, they could also alter the bioavailability of antibiotics in target organs.

By employing targeted strategies to monitor and reduce IAP, optimize ventilation, provide hemodynamic support, and adhere to antibiotic stewardship and infection control measures, healthcare providers can improve outcomes for these vulnerable patients.

To our knowledge, there are no published data on this topic.

Hence, targeted large-scale studies should explore this correlation. With the emergence of MDR bacteria, continued research and innovation are needed to develop more effective interventions and improve survival rates in this high-risk group.

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