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Intra-Abdominal Hypertension, Abdominal Compartment Syndrome and the Open Abdomen: Looking Beyond the Obvious to New Understandings in Pathophysiology, Harm-Reduction and Systemic Therapies

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Intensive Care for Emergency Surgeons

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

Abstract

The abdominal organs are subject to marked functional changes due to alterations in both physical pressure and perfusion due to the nature of the viscera themselves, the tendency for inflammatory fluid to accumulate within the abdominal compartment, and even physical changes in the container and contiguous body cavities. When intra-compartment pressure is abnormally increased, this situation is designated as intra-abdominal hypertension (IAH). When IAH is to a degree that causes new and overt organ failure, the abdominal compartment syndrome (ACS) is defined. When the overt ACS ensues with catastrophic cardiorespiratory collapse, urgent laparotomy without subsequent abdominal wall closure is required to prevent death. The resulting open abdomen (OA), while lifesaving in this situation, introduces another series of risks to the patient that must be mitigated by a temporary abdominal closure (TAC) device. With only embarrassingly recent worldwide rationalization of fluid resuscitation strategies during critical injury and illness, the remarkable degree of iatrogenicity in cases of overt ACS is increasingly being appreciated. When balanced resuscitation formulas with increased blood and plasma and dramatically reduced volumes of crystalloid fluids are utilized, markedly reduced rates of IAH/ACS are seen. After traumatic injury the rationale for the use of the OA is increasingly being questioned. Comparatively however, the use of the OA after source control laparotomies for intraperitoneal sepsis is increasingly being adopted without strong controlled evidence to its effectiveness. This has been partially supported by developments in TAC devices that offer greater safety and potentially even a therapeutic modality to mitigate the biomediator propagation leading to systemic inflammation in IAS. Thus, controlled studies to determine optimal therapies are urgently required.

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Authors and Affiliations

  1. Departments of Critical Care Medicine and Surgery, Foothills Medical Centre, Calgary, AB, Canada

    Andrew W. Kirkpatrick

  2. Division of Vascular and Endovascular Surgery, University of Ottawa, Ottawa, ON, Canada

    Derek J. Roberts

  3. General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy

    Federicco Coccolini

Authors
  1. Andrew W. Kirkpatrick
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  2. Derek J. Roberts
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  3. Federicco Coccolini
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Correspondence to Andrew W. Kirkpatrick .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy

    Edoardo Picetti

  2. Division of Trauma, Department of Surgery, University of Campinas, Campinas, São Paulo, Brazil

    Bruno M. Pereira

  3. Department of Surgery, McGill University, Montreal, QC, Canada

    Tarek Razek

  4. Department of Surgery/ Division of Trauma, Burns, Critical and Acute Care, Weill Cornell Medicine/ New York-Presbyterian Hospital, New York, USA

    Mayur Narayan

  5. Department of Surgery, Tel Aviv University, Tel Aviv, Israel

    Jeffry L. Kashuk

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Kirkpatrick, A.W., Roberts, D.J., Coccolini, F. (2019). Intra-Abdominal Hypertension, Abdominal Compartment Syndrome and the Open Abdomen: Looking Beyond the Obvious to New Understandings in Pathophysiology, Harm-Reduction and Systemic Therapies. In: Picetti, E., Pereira, B., Razek, T., Narayan, M., Kashuk, J. (eds) Intensive Care for Emergency Surgeons. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-11830-3_13

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