The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world.

One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay.

IAH is associated with high morbidity and mortality.

Although considerable progress has been made over the past decades, some important questions remain regarding the optimal ventilation management in patients with IAH.

An important first step is to measure intra-abdominal pressure (IAP). If IAH (IAP > 12 mmHg) is present, medical therapies should be initiated to reduce IAP as small reductions in intra-abdominal volume can significantly reduce IAP and airway pressures.

Protective lung ventilation with low tidal volumes in patients with respiratory failure and IAH is important. Abdominal-thoracic pressure transmission is around 50%.

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