Table of contents
Abdominal compartment syndrome
Abdominal compartment syndrome is a critical condition characterized by elevated intra-abdominal pressure that leads to multi-system organ dysfunction. It is defined as an intra-abdominal pressure > 20 mmHg with evidence of organ failure.
The pathophysiology involves a rapid increase in intra-abdominal pressure due to factors such as internal bleeding, inflammation, or fluid accumulation within the abdominal cavity. This elevated pressure can impede blood flow and oxygen delivery to the organs, leading to ischemia and organ dysfunction.
The epidemiology of abdominal compartment syndrome varies according to the patient population. It is commonly seen in critically ill patients, particularly those in the ICU.
Clinically, abdominal compartment syndrome presents with a firm, tense abdomen, increased peak inspiratory pressures, and oliguria, all of which improve after abdominal decompression.
Prognosis and risk of recurrence
The prognosis is significantly influenced by early recognition and intervention. If left untreated, it can lead to severe complications and an increased mortality rate.
The following summarized guidelines for the evaluation and management of abdominal compartment syndrome are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES 2018), the European Society for Vascular Surgery (ESVS 2017), the European Society of Intensive Care Medicine (ESICM 2017), and the World Society of the Abdominal Compartment Syndrome (WSACS 2013).
Measurement of intra-abdominal pressure: as per WSES 2018 guidelines, obtain intra-abdominal pressure measurement in critically ill patients at risk for intra-abdominal hypertension/abdominal compartment syndrome.
Supportive care: consider providing optimal pain and anxiety relief in critically ill or trauma patients.
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Neuromuscular blocking agents
Blood product transfusion: consider using an enhanced ratio of plasma/PRBCs for resuscitation of massive hemorrhage.
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Percutaneous catheter drainage
Decompressive laparotomy: as per WSES 2018 guidelines, recognize that risk factors for abdominal compartment syndrome, such as damage control surgery, injuries requiring packing and planned reoperation, extreme visceral or retroperitoneal swelling, obesity, elevated bladder pressure when abdominal closure is attempted, abdominal wall tissue loss, and aggressive resuscitation, are predictors of the necessity for open abdomen in patients with trauma.
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Patients with open abdominal wounds
Utilize negative pressure wound therapy in critically ill/injured patients with open abdominal wounds.
Attempt to perform an early or at least same-hospital-stay abdominal fascial closure in ICU patients with open abdominal wounds.