A 62-year-old man (weight 70 kg) with severe acute pancreatitis is admitted to the ICU. He is intubated, receiving assist-control ventilation, and requires norepinephrine to maintain a mean arterial pressure above 65 mmHg. Over the past 12 hours, his intra-abdominal pressure has risen to 24 mmHg, and he has developed oliguria (0.3 mL/kg/hr) with serum creatinine increasing from 0.9 to 1.8 mg/dL. He is receiving meropenem 1 g IV every 8 hours for suspected pancreatic necrosis. Which pharmacokinetic adjustment is MOST critical for his current meropenem regimen?

A 62-year-old man with severe acute pancreatitis is intubated on assist-control ventilation (PEEP 10 cmH2O, FiO2 60%) and receiving norepinephrine at 0.1 µg/kg/min. Over the past 12 hours, his urine output has fallen to 0.2 mL/kg/hr and serum creatinine has risen from 1.0 to 2.5 mg/dL. Bladder pressures are 18 mmHg and 22 mmHg, 4 hours apart, confirming abdominal compartment syndrome with new acute kidney injury. Central venous pressure is 14 mmHg and IVC distensibility index is 8%, indicating he is not fluid responsive. He is sedated with propofol and receives intermittent rocuronium boluses for ventilator synchrony. To minimize the risk of prolonged paralysis and facilitate clinical assessment in the setting of AKI, which neuromuscular blockade adjustment is most appropriate?

A 48-year-old, 75-kg man with severe acute pancreatitis is admitted to the intensive care unit. He is managed with assist-control ventilation, a norepinephrine infusion at 0.1 mcg/kg/min, and has received 6 L of intravenous fluids over the past 12 hours. His urine output has decreased to 0.2 mL/kg/hr (≈15 mL/hr), and his abdomen is increasingly distended. An intra-abdominal pressure (IAP) measurement via bladder monitoring is 22 mmHg. Which of the following is the most appropriate initial step to manage this patient’s intra-abdominal pressure?

A 62-year-old man with severe acute pancreatitis is admitted to the ICU. His intravesical intra-abdominal pressure (IAP) has remained above 22 mmHg for the past 12 hours, and he has developed new-onset oliguria (0.3 mL/kg/hr) despite adequate fluid resuscitation. Which of the following monitoring parameters is most critical for assessing the efficacy of interventions aimed at resolving his abdominal compartment syndrome (ACS)?

A 45-year-old male with severe acute pancreatitis is admitted to the ICU. He is intubated and on assist-control ventilation with rising peak inspiratory pressures (P_peak 35 cmH2O). A central venous catheter is in place, and he is receiving norepinephrine at 0.08 mcg/kg/min to maintain MAP > 65 mmHg. Over the past 12 hours his urine output has decreased to 0.2 mL/kg/hr, and his abdomen is distended and tense. Bladder catheter measurements of intra-abdominal pressure are 18 mmHg and 20 mmHg, taken 3 hours apart. His cumulative fluid balance over 24 hours is +8 L. Which of the following interventions is most appropriate to manage intra-abdominal hypertension and prevent progression to abdominal compartment syndrome?

A 62-year-old man with severe acute pancreatitis is in the critical care unit. He is intubated and on assist-control mechanical ventilation due to worsening respiratory distress, requiring high inspiratory pressures. A central venous catheter is in place, and he is receiving a norepinephrine infusion at 0.1 mcg/kg/min to maintain a mean arterial pressure (MAP) above 65 mmHg. Over the past 6 hours, his urine output has decreased to 0.2 mL/kg/hr, and his abdomen has become increasingly distended and tense on palpation. An objective measurement of intra-abdominal pressure (IAP) has not yet been performed. Given the patient’s clinical presentation, which of the following monitoring strategies is MOST critical to confirm the diagnosis of abdominal compartment syndrome and guide immediate management?

A 45-year-old, 70 kg male is admitted to the ICU with severe acute pancreatitis. He is on assist-control mechanical ventilation and receiving a norepinephrine infusion via a central line. Over the past 24 hours he has received 8 L of crystalloid. His intra-abdominal pressure measured via bladder technique has risen from 12 mmHg to 22 mmHg. He is oliguric (0.3 mL/kg/hr) and his creatinine has increased from 0.9 mg/dL to 1.8 mg/dL. Which of the following is the highest priority intervention to reduce intra-abdominal pressure and prevent further organ dysfunction?

A 62-year-old man with severe acute pancreatitis is in the critical care unit. He is intubated on assist-control mechanical ventilation due to worsening respiratory distress, requiring high inspiratory pressures. A central venous catheter is in place, and he is receiving a norepinephrine infusion at 0.1 mcg/kg/min to maintain a mean arterial pressure (MAP) above 65 mmHg. Over the past 6 hours, his urine output has decreased to 0.2 mL/kg/hr, and his abdomen has become increasingly distended and tense on palpation. An objective measurement of intra-abdominal pressure (IAP) has not yet been performed. Given the patient’s clinical presentation, which of the following monitoring strategies is MOST critical to confirm the diagnosis of abdominal compartment syndrome and guide immediate management?

A 62-year-old man (weight 80 kg) is admitted to the ICU with severe acute pancreatitis. On hospital day 2, he remains hypotensive requiring a continuous norepinephrine infusion at 0.1 mcg/kg/min via a central venous catheter. His blood pressure is 85/50 mmHg (mean arterial pressure 62 mmHg) on this dose, and his heart rate is 110 bpm. Over the past 12 hours, his urine output has declined to 15 mL/hour, and his serum creatinine has risen from 1.1 to 2.0 mg/dL. His lactate is 4.2 mmol/L. He is intubated on assist-control ventilation, and peak inspiratory pressures have increased from 25 to 38 cm H₂O. Bladder pressure measurements show intra-abdominal pressures >22 mmHg on two readings taken 4 hours apart despite fluid optimization and analgesia. Given the sustained elevation in intra-abdominal pressure and new organ dysfunction, which of the following is the most appropriate next step in management?

A 62-year-old man with severe acute pancreatitis is in the intensive care unit. He was intubated and placed on assist-control ventilation for refractory hypoxia, required a norepinephrine infusion for hypotension, and developed acute kidney injury. Intra-abdominal pressure (IAP) measurements via a bladder catheter were consistently >22 mmHg. Over the past 24 hours, his condition has improved: the norepinephrine has been weaned off, creatinine is trending down, and his IAP has decreased to 15 mmHg on two consecutive measurements 4 hours apart. Given this clinical trajectory, which action is most appropriate for managing this patient’s intra-abdominal pressure monitoring?