IAP MONITORING • A low threshold for early use of IAP monitoring is essential • A standardized technique and infusion volume will be defined to facilitate comparison of techniques and results • Continuous IAP monitoring is the next logical step
APP MONITORING • APP is more important than IAP alone • Resuscitation should be based upon APP • Minimize IAP • Avoid overresuscitation • Decompress abdomens early • Maximize APP • Judicious fluid resuscitation • Vasoactive medications to optimize MAP • Decompress if fail to maintain APP > 60 mmHg
USE YOUR BRAIN! • Pay close attention to the patient • Use PAOP / CVP with caution • Volumetric parameters are superior to intracardiac filling pressures
THE FORGOTTEN ORGANS • We need to remember the other organs and monitor them for malperfusion • Brain ICP • Gut PrCO2 • Liver ICG clearance • Kidney ???
THE FUTURE • We need improved monitoring techniques that allow an assessment of each organ system • Regional perfusion adequacy is mandatory • We all have a lot to learn and even more to develop in the years to come