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.
Abdominal compartment syndrome (ACS) occurs when the intra-abdominal pressure (IAP) rises to a level that impairs organ perfusion, causing new organ dysfunction. It is defined as a sustained IAP over 20 mmHg and/or an abdominal perfusion pressure below 60 mmHg.
History and exam
Michael W. Cripps, MD
Department of Surgery
Division of Burn/Trauma/Critical Care
University of Texas Southwestern Medical Center
MWC has been reimbursed by Hemosonics and Instrumentation Laboratory for consultancy.
Jeffrey C. Perumean, MD
Advanced Surgical Associates/Banner Health
Division of Trauma/Critical Care
JCP declares that he has no competing interests.
Dr Michael Cripps and Dr Jeffrey Perumean would like to gratefully acknowledge Dr Michaela West and Dr Gary An, previous contributors to this topic. MW and GA are authors of a reference cited in this topic.
Michael L. Cheatham, MD, FACS, FCCM
Orlando Regional Medical Center
MLC is an author of a number of references cited in this topic. MLC is a member of the World Society of the Abdominal Compartment Syndrome.
Bart De Keulenaer, MD, FJFICM
BDK declares that he has no competing interests.
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