The abdominal compartment syndrome occurs when raised intra-abdominal pressure is associated with signs of organ failure in critically ill patients.
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 |
Specialty: Critical Care, Emergency Medicine, Surgery, general, Gastroenterology