Abdominal Compartment Syndrome
Patients with abdominal compartment syndrome typically present after trauma, abdominal surgery, or massive fluid resuscitation and will have a distended abdomen, low urine output, hypotension, and increased airway pressures. To measure intra-abdominal pressure (IAP), a bladder pressure should be obtained with pressures >20 mmHg suggesting compartment syndrome. Computed tomography (CT) scan may show compressed inferior vena cava which will result in decreased cardiac output leading to malperfusion of the viscera and kidneys. Noninvasive and invasive treatments can decrease intra-abdominal pressures in the setting of abdominal compartment syndrome. Supportive measures included removal of intraluminal contents, intra-abdominal ascites, or hematomas; avoiding positive fluid balance after initial resuscitation; improving abdominal wall compliance with analgesia, sedation, and paralysis; decreasing head elevation; escharotomy in burn victims; and removal of constrictive binders or dressings. Vasopressors may be used to maintain an abdominal perfusion pressure >60 mmHg. IAP should be measured at least every 4 h while patient is critically ill or with elevated IAP. Decompressive laparotomy is the definitive treatment, and temporary closure with delayed primary closure may be necessary.
KeywordsAbdominal compartment syndrome Intra-abdominal hypertension Critical care Intra-abdominal pressure Temporary abdominal closure Abdominal trauma Abdominal perfusion pressure Open abdomen