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Anatomy and Physiology of the Abdominal Compartment

  • Manu L. N. G. Malbrain
  • Brecht De Tavernier
  • Pieter-Jan Van Gaal
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Increasing attention has been paid to understanding the etiology, pathophysiology, prognosis, and treatment of increased intra-abdominal pressure (IAP) in surgical, trauma, and medical patients. Intra-abdominal hypertension (IAH) is a graded phenomenon; however, abdominal compartment syndrome (ACS) is an all-or-none condition resulting in dysfunction of neurological, respiratory, cardiovascular, renal, and hepatic organ systems. This chapter provides a detailed overview of the historical background, definitions, classification, epidemiology, and pathophysiology related to IAH and ACS, including different IAP measurement techniques.

Notes

Acknowledgments

Dr. MLNG Malbrain is the founding president of WSACS and current treasurer; he is a member of the medical advisory board of Pulsion Medical Systems (Maquet Getinge group), a monitoring company, and consults for KCI, ConvaTec, and Holtech Medical. He is also a member of the Executive Committee of the International Fluid Academy, an online educational platform adhering to the FOAM principles (Free Open Access Medical Education, www.fluidacademy.org), and part of the not-for-profit organization iMERiT (International Medical Education and Research Initiative). The other authors have no potential conflicts of interest.

References

  1. 1.
    Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med. 2006;32(11):1722–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33(6):951–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, 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(7):1190–206.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33(2):315–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004;30(5):822–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Malbrain ML, Chiumello D, Cesana BM, Reintam Blaser A, Starkopf J, Sugrue M, et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on abdominal hypertension epidemiology, a unifying project (WAKE-Up!). Minerva Anestesiol. 2014;80(3):293–306.PubMedGoogle Scholar
  7. 7.
    Malbrain MLNG, Roberts DJ, Sugrue M, De Keulenaer BL, Ivatury R, Pelosi P, et al. The polycompartment syndrome: a concise state-of-the-art review. Anaesthesiol Intensive Ther. 2014;46(5):433–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Van Hee R. Historical highlights in concept and treatment of abdominal compartment syndrome. Acta Clin Belg Suppl. 2007;62(1):9–15.Google Scholar
  9. 9.
    Emerson H. Intra-abdominal pressures. Arch Intern Med. 1911;7(6):754–84.CrossRefGoogle Scholar
  10. 10.
    Kirkpatrick AW, De Waele JJ, De Laet I, De Keulenaer BL, D’Amours S, Bjorck M, et al. WSACS--The Abdominal Compartment Society. A Society dedicated to the study of the physiology and pathophysiology of the abdominal compartment and its interactions with all organ systems. Anaesthesiol Intensive Ther. 2015;47(3):191–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Malbrain MLNG, De laet I, De Waele J, Sugrue M, Schachtrupp A, Duchesne J, et al. The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 2: measurement techniques and management recommendations. Anaesthesiol Intensive Ther. 2014;46(5):406–32.CrossRefPubMedGoogle Scholar
  12. 12.
    Malbrain MLNG, Roberts DJ, De laet I, De Waele J, Sugrue M, Schachtrupp A, et al. The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 1: definitions and pathophysiology. Anaesthesiol Intensive Ther. 2014;46(5):392–405.CrossRefPubMedGoogle Scholar
  13. 13.
    Song C, Alijani A, Frank T, Hanna GB, Cuschieri A. Mechanical properties of the human abdominal wall measured in vivo during insufflation for laparoscopic surgery. Surg Endosc. 2006;20(6):987–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Forstemann T, Trzewik J, Holste J, Batke B, Konerding MA, Wolloscheck T, et al. Forces and deformations of the abdominal wall--a mechanical and geometrical approach to the linea alba. J Biomech. 2011;44(4):600–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Flament JB. [Functional anatomy of the abdominal wall]. Der Chirurg Zeitschrift fur alle Gebiete der operativen Medizen 2006;77(5):401–7.CrossRefGoogle Scholar
  16. 16.
    Brown SH. Mechanically relevant consequences of the composite laminate-like design of the abdominal wall muscles and connective tissues. Med Eng Phys. 2012;34(4):521–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Malbrain ML, Peeters Y, Wise R. The neglected role of abdominal compliance in organ-organ interactions. Crit Care. 2016;20:67.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada JR. Abdominal distention results from caudo-ventral redistribution of contents. Gastroenterology. 2009;136(5):1544–51.CrossRefPubMedGoogle Scholar
  19. 19.
    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(8):588–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Mulier JP, Dillemans B, Van Cauwenberge S. Impact of the patient’s body position on the intraabdominal workspace during laparoscopic surgery. Surg Endosc. 2010;24(6):1398–402.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mulier J, Dillemans B, Crombach M, Missant C, Sels A. On the abdominal pressure volume relationship. Int J Anesthesiol. 2008;21(1):5221–31.Google Scholar
  22. 22.
    Holodinsky JK, Roberts DJ, Ball CG, Blaser AR, Starkopf J, Zygun DA, 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(5):R249.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am. 1996;76(4):833–42.CrossRefPubMedGoogle Scholar
  24. 24.
    Ivatury RR, Sugerman HJ, Peitzman AB. Abdominal compartment syndrome: recognition and management. Adv Surg. 2001;35:251–69.PubMedGoogle Scholar
  25. 25.
    De Waele JJ, Ejike JC, Leppaniemi A, De Keulenaer BL, De Laet I, Kirkpatrick AW, et al. Intra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma. Anaesthesiol Intensive Ther. 2015;47(3):219–27.CrossRefPubMedGoogle Scholar
  26. 26.
    Malbrain ML, De Keulenaer BL, Oda J, De Laet I, De Waele JJ, Roberts DJ, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine. Anaesthesiol Intensive Ther. 2015;47(3):228–40.CrossRefPubMedGoogle Scholar
  27. 27.
    Vidal MG, Ruiz Weisser J, Gonzalez F, Toro MA, Loudet C, Balasini C, et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med. 2008;36(6):1823–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA, et al. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003;54(5):848–59. discussion 59–61CrossRefPubMedGoogle Scholar
  29. 29.
    Peeters Y, Lebeer M, Wise R, Malbrain ML. An overview on fluid resuscitation and resuscitation endpoints in burns: past, present and future. Part 2 - avoiding complications by using the right endpoints with a new personalized protocolized approach. Anaesthesiol Intensive Ther. 2015;47(J):15–26.CrossRefGoogle Scholar
  30. 30.
    Peeters Y, Vandervelden S, Wise R, Malbrain ML. An overview on fluid resuscitation and resuscitation endpoints in burns: past, present and future. Part 1 - historical background, resuscitation fluid and adjunctive treatment. Anaesthesiol Intensive Ther. 2015;47:6–14.CrossRefGoogle Scholar
  31. 31.
    Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004;30(3):357–71.CrossRefPubMedGoogle Scholar
  32. 32.
    Desie N, Willems A, De Laet I, Dits H, Van Regenmortel N, Schoonheydt K, et al. Intra-abdominal pressure measurement using the FoleyManometer does not increase the risk for urinary tract infection in critically ill patients. Ann Intensive Care. 2012;2(Suppl 1):S10.PubMedPubMedCentralGoogle Scholar
  33. 33.
    De Potter TJ, Dits H, Malbrain ML. Intra- and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring. Intensive Care Med. 2005;31(5):747–51.CrossRefPubMedGoogle Scholar
  34. 34.
    Malbrain ML, Wilmer A. The polycompartment syndrome: towards an understanding of the interactions between different compartments! Intensive Care Med. 2007;33(11):1869–72.CrossRefPubMedGoogle Scholar
  35. 35.
    Malbrain ML, De Waele JJ, De Keulenaer BL. What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension. Anaesthesiol Intensive Ther. 2015;47(4):388–99.CrossRefPubMedGoogle Scholar
  36. 36.
    De Laet I, Citerio G, Malbrain ML. The influence of intraabdominal hypertension on the central nervous system: current insights and clinical recommendations, is it all in the head? Acta Clin Belg Suppl. 2007;62(1):89–97.CrossRefGoogle Scholar
  37. 37.
    Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg Suppl. 2007;62(1):78–88.CrossRefGoogle Scholar
  38. 38.
    De laet I, Malbrain ML, Jadoul JL, Rogiers P, Sugrue M. Renal implications of increased intra-abdominal pressure: are the kidneys the canary for abdominal hypertension? Acta Clin Belg Suppl. 2007;62(1):119–30.CrossRefGoogle Scholar
  39. 39.
    Ameloot K, Gillebert C, Desie N, Malbrain ML. Hypoperfusion, shock states, and abdominal compartment syndrome (ACS). Surg Clin North Am. 2012;92(2):207–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Kron IL. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med. 1989;17(7):714–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Manu L. N. G. Malbrain
    • 1
    • 2
    • 3
  • Brecht De Tavernier
    • 1
  • Pieter-Jan Van Gaal
    • 1
  1. 1.Department of Intensive Care Unit and High Care Burn UnitZiekenhuis Netwerk Antwerpen, ZNA StuivenbergAntwerpen 6Belgium
  2. 2.University Hospital Brussels (UZB)JetteBelgium
  3. 3.Faculty of MedicineProfessor at Vrije Universiteit Brussel (VUB)BrusselsBelgium

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