Elsevier

Critical Care Clinics

Volume 32, Issue 2, April 2016, Pages 213-222
Critical Care Clinics

Abdominal Compartment Hypertension and Abdominal Compartment Syndrome

https://doi.org/10.1016/j.ccc.2015.12.001Get rights and content

Section snippets

Key points

  • Abdominal compartment hypertension and syndrome should be expected following resuscitation in patients with an increase in the intraperitoneal contents (including tense ascites), and in those with decreased abdominal wall compliance.

  • Measurement of bladder pressure is the standard of care by which intra-abdominal pressure should be measured in the intensive care unit in most instances.

  • Abdominal hypertension is present when abdominal pressure exceeds 12 mm Hg and abdominal compartment syndrome is

Definition and causes of intra-abdominal hypertension/abdominal compartment syndrome

The most commonly used definition of ACS was published by the World Society on Abdominal Compartment Syndrome (WSACS) in 2013.4 This consensus document addresses clinical definitions and pressure measurement guidelines intended to assist clinicians and researchers in the diagnosis, treatment, and characterization of IAH/ACS. Intra-abdominal pressure (IAP) is defined as the end-expiratory abdominal pressure in the supine position in the setting of fully relaxed abdominal wall musculature.

Diagnosis: physiologic markers of abdominal compartment syndrome

Early recognition of IAH is the essential first step in preventing ACS. A protocol for initiation of IAP measurements based on known risk factors and/or clinical suspicion is vital. IAP should be measured in patients with 2 or more of the risk factors listed in Box 1.13

Cephalad pressure on the diaphragm decreases functional residual capacity and tidal volume.14 This degradation in lung volumes is exacerbated by increasing IAP.15 Patients with ACS require mechanical ventilation because of an

Diagnosis: measurement of abdominal pressure

Clinical examination alone is insufficient in the diagnosis of IAH. In a prospective study of 110 consecutive intensive care unit (ICU) patients who had undergone abdominal surgery, an intensivist’s clinical estimation of IAP was compared with a quantified measurement and was shown to have only 61% sensitivity for detecting an IAP greater than 18 mm Hg.2, 28 Because clinical examination alone is unreliable, objective IAP measurements are necessary to guide management of critically ill patients

Treatment

Appropriate treatment of ACS requires rapid normalization of the IAP, thereby restoring normal abdominal visceral perfusion and resolving the aforementioned cardiopulmonary functional impairments. Definitive management of ACS from most causes other than tense ascites, which can be treated by large-volume paracentesis, involves emergent surgical decompression of the abdomen via a midline laparotomy, often performed at the bedside in the ICU. However, this may be extremely morbid and should be

Summary

The resuscitation of critically ill or injured patients can result in IAH and ACS. In addition, certain chronic medical conditions, such as cirrhosis, portend significant risk for IAH and ACS when patients are critically ill. There is a significant morbidity and mortality risk associated with a delay in recognition and treatment of these conditions. Early diagnosis is the key first step in mitigating these risks; however, physical examination does not offer a sensitive means to diagnose either

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    Disclosure: The authors have nothing to disclose.

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