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.
History and exam
Key diagnostic factors
- presence of risk factors
- abdominal distension
- increased respiratory effort
- excessive fluid resuscitation (>3 L in 24 hours)
- massive blood transfusion (>10 units in 24 hours)
- decreased abdominal compliance
- intra-abdominal infection/inflammation
- loss of abdominal domain
- comorbid cirrhosis
- retroperitoneal haematoma
1st investigations to order
- trans-bladder measurement of intra-abdominal pressure
- oxygen saturation
- serum urea and creatinine
- arterial blood gases
Investigations to consider
- peak airway pressure
- abdominal CT scan
- abdominal ultrasound
- measurement of intra-abdominal pressure via vena cava, rectum, or abdominal cavity
- Acute tubular necrosis
- Acute renal failure
- Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines
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