Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with significant morbidity and mortality. Nonoperative medical management strategies play an important role in the current treatment of IAH and ACS. There are five medical treatment options to be considered to reduce elevated intra-abdominal pressure (IAP): 1) improvement of abdominal wall compliance; 2) evacuation of intraluminal contents; 3) evacuation of abdominal fluid collections; 4) optimization of systemic and regional perfusion; and 5) correction of positive fluid balance. Nonsurgical management is an important treatment option in critically ill patients with raised IAP.