Summary

• Occurs when the intra-abdominal pressure (IAP) rises to a level (>20 mmHg) that impairs organ perfusion, causing organ dysfunction.
• Most commonly due to excessive fluid resuscitation (>5 L in 24 hours) or massive blood transfusion (>10 units in 24 hours).
• Clinical signs are non-specific and appear late. Classical findings are of increased airway pressure, decreased urine output, and a tense abdomen.
• Diagnosis depends on proactive monitoring of IAP in patients with risk factors.
• Medical options to decrease IAP include evacuation of intra-luminal contents, optimisation of fluid balance, correct body positioning, adequate analgesia, and, in severe cases, neuromuscular blockade.
• Definitive treatment is surgical abdominal decompression; reserved for patients in whom medical interventions fail.
• Fatal if left untreated. Even with treatment, mortality is high.