Abdominal compartment syndrome

Abdominal compartment syndrome is 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 intra-abdominal pressure (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.

Abdominal compartment syndrome (ACS) is a sustained IAP over 20 mmHg, with or without an abdominal perfusion pressure below 60 mmHg, that is associated with new organ dysfunction or failure.[1]The World Society of the Abdominal Compartment Syndrome. WSACS consensus guidelines summary. Apr 2021 [internet publication]. https://www.wsacs.org/education/436/wsacs-consensus-guidelines-summary