Criteria for the Abdominal Compartment Syndrome

 

Settings:

(1) after abdominal surgery

(2) in injured patients, with or without abdominal trauma

(3) critically ill patients, including patients with burns, sepsis or ascites

 

Criteria for the diagnosis of the abdominal compartment syndrome:

(1) elevated intra-abdominal pressure (>= 25 mm Hg)

(2) one or more of the following, indicating organ damage

(2a) oliguria

(2b) raised pulmonary pressure

(2c) hypoxia

(2d) decreased cardiac output

(2e) hypotension

(2f) acidosis

(3) abdominal decompression results in clinical improvement

 

where:

• Pressure in the urinary bladder correlates with the actual intra-abdominal pressure over the pressure range of 5-70 mm Hg. It can be measured with the patient in the supine position, a Foley catheter in the bladder and a water pressure manometer held at the level of the symphysis pubis (Meldrum et al, 1997).

 

Complications:

(1) failure in one or more organs (heart. lung, kidneys)

(2) breakdown of surgical sites

(3) impaired blood flow with decreased visceral perfusion

(4) intestinal obstruction

 

Management:

(1) prompt abdominal decompression when the pressure becomes elevated

(2) prevention through the use of tension-free abdominal closures

 

Meldrum et al (1997) developed a grading system based on intra-abdominal pressure levels, with recommended management steps.

Pressure	Grade	Management
10-15 mm Hg	I	maintain normovolemia
16-25 mm Hg	II	hypervolemic resuscitation
26-35 mm Hg	III	decompression
> 35 mm Hg	IV	decompression and re-exploration