29/05/2023
Abdominal compartment syndrome
Abdominal compartment syndrome is a medical emergency that can occur in critically ill people, such as those in the intensive care unit.
Normal intra-abdominal pressure ranges between 0 and 5 millimeters of mercury (mmHg). In critically ill people, the range is between 5 and 7 mmHg. High intra-abdominal pressure may be defined as:
Intra-abdominal hypertension (IAH), in which pressure is 12 to 20 mmHg.
Abdominal compartment syndrome (ACS), in which pressure is higher than 20 mmHg.
Caused by increase intra-abdominal pressure(intra-abdominal hypertension)
Raised IAP affects every system and main organ in the human body.
Causes ✅
Major trauma
Postoperative hemorrhage(ruptured AAA)
Bowel wall oedema
Acute ascites
Major burns
Pancreatitis
Intestinal obstruction
Clinical features ✅
Abdominal Distention
Oliguria
Airway obstruction
Occult blood loss
Hypoxia
Bowel ischemia
Cardiac arrest
Renal failure
Diagnosis of IAP ✅
Physical examination
Chest x ray
Electrolytes
FBC
USG/ultrasound/CT scan
Serum creatinine
Amylase
Aptt and ptt
ABG
WSACS guidelines ✅
The World Society of the Abdominal Compartment Syndrome has published the following definitions and recommendations
IAH is graded as follows: Grade I: IAP 12-15 mm Hg; Grade II: IAP 16-20 mm Hg; Grade III: IAP 21-25 mm Hg; Grade IV: IAP >25 mm Hg.
Patients should be screened for IAH/ACS risk factors upon ICU admission and in the presence of new or progressive organ failure.
APP should be maintained above 50-60 mm Hg in patients with IAH/ACS [Abdominal perfusion pressure (APP) = mean arterial pressure (MAP) – IAP].
Fluid resuscitation volume should be carefully monitored to avoid overresuscitation in patients at risk for IAH/ACS.
Hypertonic crystalloid and colloid-based resuscitation should be considered in patients with IAH to decrease the progression to secondary ACS.
Surgical decompression should be performed in patients with ACS that is refractory to other treatment options.
Presumptive decompression should be considered at the time of laparotomy in patients who demonstrate multiple risk factors for IAH/ACS.
treatment of abdominal compartment syndrome ✅
hemodynamics
Target MAP > (60 mm + abdominal compartment pressure).
Don’t give additional fluid.
Consider diuresis/dialysis, if possible.
decompress the abdomen
Ascites: Drain (indwelling catheter might be ideal approach).
NPO, Gastric tube to suction.
Decompress the colon (e.g., suppositories, neostigmine for megacolon).
Fascial release is definitive treatment, but most invasive. Reserve this for failure of other measures.
Decompress the thorax
Large pleural effusion: consider drainage.
Avoid intubation if able.
Reduce airway pressures as able (e.g., target low PEEP & plateau pressures).
sedation & paralysis (if intubated)
Start with analgesia/sedation to target a passive state on ventilator.
Paralysis may be used as a short-term therapy.
Diagnostic Considerations
The differential diagnosis includes the following:
Abdominal Trauma, Blunt
Appendicitis, Acute
Cholangitis
Congestive Heart Failure and Pulmonary Edema
Dissection, Aortic
Diverticular Disease
Foreign Bodies, Gastrointestinal
Mesenteric Ischemia
Pediatrics, Bacteremia and Sepsis
Urinary Obstruction
