Skip to main content
SpringerLink
Log in

Abdominal Compartment Hypertension and Abdominal Compartment Syndrome

  • Chapter
  • First Online:
Book cover Principles of Adult Surgical Critical Care

Abstract

Abdominal hypertension and compartment syndrome are frequent events following large-volume fluid resuscitation, complex ventral herniorrhaphy, pancreatitis, and other common disorders in the ICU. Early signs and symptoms heralding IAH and ACS lack sensitivity, and a high index of suspicion is needed to diagnose these problems early. Failure to recognize ACS, in particular, is associated with increased mortality related to multisystem organ failure. Whereas abdominal decompression remains the gold standard of treatment, other nonoperative treatment options, such as paracentesis and pharmacologic paralysis, can be used in selected instances. When a decompressive laparotomy is performed, timely closure of the abdominal wall is essential to minimize risk of development of an entero-atmospheric fistula and loss of domain ventral hernia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Balogh Z, McKinley BA, Cocanour CS, et al. Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg. 2002;184:538–43; discussion 43–4.

    PubMed  Google Scholar 

  2. Balogh Z, McKinley BA, Holcomb JB, et al. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003;54:848–59; discussion 59–61.

    PubMed  Google Scholar 

  3. Department of Surgical Education. Intraabdominal pressure monitoring. In: Orlando; 2008. Available at: http://www.surgicalcriticalcare.net/Guidelines/intraabdominal_pressure_monitoring.pdf. Accessed 11/20/2015.

    Google Scholar 

  4. Vidal MG, Ruiz Weisser J, Gonzalez F, et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med. 2008;36:1823–31.

    PubMed  Google Scholar 

  5. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.

    PubMed  PubMed Central  Google Scholar 

  6. Sanchez NC, Tenofsky PL, Dort JM, Shen LY, Helmer SD, Smith RS. What is normal intra-abdominal pressure? Am Surg. 2001;67:243–8.

    CAS  PubMed  Google Scholar 

  7. Hering R, Wrigge H, Vorwerk R, et al. The effects of prone positioning on intra-abdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg. 2001;92:1226–31.

    CAS  PubMed  Google Scholar 

  8. Wilson A, Longhi J, Goldman C, McNatt S. Intra-abdominal pressure and the morbidly obese patients: the effect of body mass index. J Trauma. 2010;69:78–83.

    PubMed  Google Scholar 

  9. Madigan MC, Kemp CD, Johnson JC, Cotton BA. Secondary abdominal compartment syndrome after severe extremity injury: are early, aggressive fluid resuscitation strategies to blame? J Trauma. 2008;64:280–5.

    PubMed  Google Scholar 

  10. Regueira T, Bruhn A, Hasbun P, et al. Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock. J Crit Care. 2008;23:461–7.

    CAS  PubMed  Google Scholar 

  11. Reintam Blaser A, Parm P, Kitus R, Starkopf J. Risk factors for intra-abdominal hypertension in mechanically ventilated patients. Acta Anaesthesiol Scand. 2011;55:607–14.

    CAS  PubMed  Google Scholar 

  12. Reintam Blaser A, Parm P, Kitus R, Starkopf J. Intra-abdominal hypertension and gastrointestinal symptoms in mechanically ventilated patients. Crit Care Res Pract. 2011;2011:982507.

    PubMed  PubMed Central  Google Scholar 

  13. Kasotakis G, Duggan M, Li Y, et al. Optimal pressure of abdominal gas insufflation for bleeding control in a severe swine splenic injury model. J Surg Res. 2013;184:931–6.

    PubMed  Google Scholar 

  14. Neal MD, Hoffman MK, Cuschieri J, et al. Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way. J Trauma Acute Care Surg. 2012;72:892–8.

    PubMed  PubMed Central  Google Scholar 

  15. Holodinsky JK, Roberts DJ, Ball CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care. 2013;17:R249.

    PubMed  PubMed Central  Google Scholar 

  16. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33:951–62.

    PubMed  Google Scholar 

  17. Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg. 1995;130:544–7; discussion 7–8.

    CAS  PubMed  Google Scholar 

  18. Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2007;62 Suppl 1:78–88.

    PubMed  Google Scholar 

  19. Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998;158:3–11.

    CAS  PubMed  Google Scholar 

  20. Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med. 1989;17:118–21.

    CAS  PubMed  Google Scholar 

  21. Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ. Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma. 1995;39:1071–5.

    CAS  PubMed  Google Scholar 

  22. Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol. 1985;248:R208–13.

    CAS  PubMed  Google Scholar 

  23. Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg. 1982;196:594–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K. Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg. 1999;134:1082–5.

    CAS  PubMed  Google Scholar 

  25. Bradley SE, Bradley GP. The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest. 1947;26:1010–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Bloomfield GL, Blocher CR, Fakhry IF, Sica DA, Sugerman HJ. Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma. 1997;42:997–1004; discussion –5.

    CAS  PubMed  Google Scholar 

  27. Diebel LN, Wilson RF, Dulchavsky SA, Saxe J. Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma. 1992;33:279–82; discussion 82–3.

    CAS  PubMed  Google Scholar 

  28. Burchard KW, Ciombor DM, McLeod MK, Slothman GJ, Gann DS. Positive end expiratory pressure with increased intra-abdominal pressure. Surg Gynecol Obstet. 1985;161:313–8.

    CAS  PubMed  Google Scholar 

  29. Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma. 1992;33:45–8; discussion 8–9.

    CAS  PubMed  Google Scholar 

  30. Bongard F, Pianim N, Dubecz S, Klein SR. Adverse consequences of increased intra-abdominal pressure on bowel tissue oxygen. J Trauma. 1995;39:519–24; discussion 24–5.

    CAS  PubMed  Google Scholar 

  31. Diebel LN, Dulchavsky SA, Brown WJ. Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma. 1997;43:852–5.

    CAS  PubMed  Google Scholar 

  32. Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intra-abdominal pressure. World J Surg. 2002;26:1428–31.

    PubMed  Google Scholar 

  33. Malbrain ML, Deeren DH. Effect of bladder volume on measured intravesical pressure: a prospective cohort study. Crit Care. 2006;10:R98.

    PubMed  PubMed Central  Google Scholar 

  34. Lee SL, Anderson JT, Kraut EJ, Wisner DH, Wolfe BM. A simplified approach to the diagnosis of elevated intra-abdominal pressure. J Trauma. 2002;52:1169–72.

    PubMed  Google Scholar 

  35. Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM. Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. Intensive Care Med. 1994;20:588–90.

    CAS  PubMed  Google Scholar 

  36. Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004;30:357–71.

    PubMed  Google Scholar 

  37. Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma. 2000;49:621–6; discussion 6–7.

    CAS  PubMed  Google Scholar 

  38. Al-Dorzi HM, Tamim HM, Rishu AH, Aljumah A, Arabi YM. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensiv Care. 2012;2 Suppl 1:S4.

    Google Scholar 

  39. De Laet I, Hoste E, Verholen E, De Waele JJ. The effect of neuromuscular blockers in patients with intra-abdominal hypertension. Intensive Care Med. 2007;33:1811–4.

    PubMed  Google Scholar 

  40. Corcos AC, Sherman HF. Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma. 2001;51:1062–4.

    CAS  PubMed  Google Scholar 

  41. Savino JA, Cerabona T, Agarwal N, Byrne D. Manipulation of ascitic fluid pressure in cirrhotics to optimize hemodynamic and renal function. Ann Surg. 1988;208:504–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. De Waele JJ, Hoste EA, Malbrain ML. Decompressive laparotomy for abdominal compartment syndrome – a critical analysis. Crit Care. 2006;10:R51.

    PubMed  PubMed Central  Google Scholar 

  43. Miller RS, Morris Jr JA, Diaz Jr JJ, Herring MB, May AK. Complications after 344 damage-control open celiotomies. J Trauma. 2005;59:1365–71; discussion 71–4.

    PubMed  Google Scholar 

  44. Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med. 2007;35:127–31.

    CAS  PubMed  Google Scholar 

  45. Agalar F, Eroglu E, Bulbul M, Agalar C, Tarhan OR, Sari M. Staged abdominal repair for treatment of moderate to severe secondary peritonitis. World J Surg. 2005;29:240–4.

    PubMed  Google Scholar 

  46. Holzheimer RG, Gathof B. Re-operation for complicated secondary peritonitis – how to identify patients at risk for persistent sepsis. Eur J Med Res. 2003;8:125–34.

    CAS  PubMed  Google Scholar 

  47. Gracias VH, Braslow B, Johnson J, et al. Abdominal compartment syndrome in the open abdomen. Arch Surg. 2002;137:1298–300.

    PubMed  Google Scholar 

  48. Fernandez L, Norwood S, Roettger R, Wilkins 3rd HE. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma. 1996;40:258–60.

    CAS  PubMed  Google Scholar 

  49. Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Goslings JC. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33:199–207.

    PubMed  Google Scholar 

  50. Weinberg JA, George RL, Griffin RL, et al. Closing the open abdomen: improved success with Wittmann Patch staged abdominal closure. J Trauma. 2008;65:345–8.

    PubMed  Google Scholar 

  51. Vertrees A, Kellicut D, Ottman S, Peoples G, Shriver C. Early definitive abdominal closure using serial closure technique on injured soldiers returning from Afghanistan and Iraq. J Am Coll Surg. 2006;202:762–72.

    PubMed  Google Scholar 

  52. Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma. 2000;48:201–6; discussion 6–7.

    CAS  PubMed  Google Scholar 

  53. Brock WB, Barker DE, Burns RP. Temporary closure of open abdominal wounds: the vacuum pack. Am Surg. 1995;61:30–5.

    CAS  PubMed  Google Scholar 

  54. Miller PR, Meredith JW, Johnson JC, Chang MC. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg. 2004;239:608–14; discussion 14–6.

    PubMed  PubMed Central  Google Scholar 

  55. Cheatham ML, Demetriades D, Fabian TC, et al. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker’s vacuum packing technique. World J Surg. 2013;37:2018–30.

    PubMed  PubMed Central  Google Scholar 

  56. Biffl WL, Moore EE, Burch JM, Offner PJ, Franciose RJ, Johnson JL. Secondary abdominal compartment syndrome is a highly lethal event. Am J Surg. 2001;182:645–8.

    CAS  PubMed  Google Scholar 

  57. Patel NY, Cogbill TH, Kallies KJ, Mathiason MA. Temporary abdominal closure: long-term outcomes. J Trauma. 2011;70:769–74.

    PubMed  Google Scholar 

  58. Sailes FC, Walls J, Guelig D, et al. Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg. 2010;64:696–8.

    CAS  PubMed  Google Scholar 

  59. Diaz Jr JJ, Guy J, Berkes MB, Guillamondegui O, Miller RS. Acellular dermal allograft for ventral hernia repair in the compromised surgical field. Am Surg. 2006;72:1181–7; discussion 7–8.

    PubMed  Google Scholar 

  60. Jin J, Rosen MJ, Blatnik J, et al. Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg. 2007;205:654–60.

    PubMed  Google Scholar 

  61. Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg. 2003;238:349–55; discussion 55–7.

    PubMed  PubMed Central  Google Scholar 

  62. Rao M, Burke D, Finan PJ, Sagar PM. The use of vacuum-assisted closure of abdominal wounds: a word of caution. Colorectal Dis. 2007;9:266–8.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, George Washington University, 2150 Pennsylvania Ave, NW, Suite 6B, Washington DC, 20037, USA

    Patrick Maluso MD & Babak Sarani MD, FACS, FCCM

Authors
  1. Patrick Maluso MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Babak Sarani MD, FACS, FCCM
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Babak Sarani MD, FACS, FCCM .

Editor information

Editors and Affiliations

  1. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Niels D. Martin

  2. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Lewis J. Kaplan

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Maluso, P., Sarani, B. (2016). Abdominal Compartment Hypertension and Abdominal Compartment Syndrome. In: Martin, N.D., Kaplan, L.J. (eds) Principles of Adult Surgical Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-33341-0_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33341-0_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33339-7

  • Online ISBN: 978-3-319-33341-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation