Summary
Definition
History and exam
Key diagnostic factors
- abdominal distension
- oliguria
- increased respiratory effort
- hypotension
Risk factors
- excessive fluid resuscitation (>3 L in 24 hours)
- massive blood transfusion (>10 units in 24 hours)
- decreased abdominal compliance
- intra-abdominal infection/inflammation
- hemoperitoneum
- ileus
- pneumoperitoneum
- loss of abdominal domain
- comorbid cirrhosis
- retroperitoneal hematoma
Diagnostic tests
1st tests to order
- transbladder measurement of intra-abdominal pressure
- oxygen saturation
- BUN and creatinine
- arterial blood gases
Tests to consider
- peak airway pressure
- abdominal CT scan
- abdominal ultrasound
Emerging tests
- measurement of intra-abdominal pressure via vena cava, rectum, or abdominal cavity
Treatment algorithm
all patients
Contributors
Authors
Michael W. Cripps, MD
Assistant Professor
Department of Surgery
Division of Burn/Trauma/Critical Care
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
MWC has been reimbursed by Hemosonics and Instrumentation Laboratory for consultancy.
Jeffrey C. Perumean, MD
Surgeon/Surgical Intensivist
Advanced Surgical Associates/Banner Health
Division of Trauma/Critical Care
Mesa
AZ
Disclosures
JCP declares that he has no competing interests.
Acknowledgements
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.
Peer reviewers
Bart De Keulenaer, MD, FJFICM
Physician/Intensivist
Fremantle Hospital
Fremantle
Western Australia
Australia
Disclosures
BDK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
The World Society of the Abdominal Compartment Syndrome. WSACS consensus guidelines summary. Apr 2021 [internet publication].Full text
An G, West MA. Abdominal compartment syndrome: a concise clinical review. Crit Care Med. 2008 Apr;36(4):1304-10. Abstract
Iberti TJ, Kelly KM, Gentili DR, et al. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med. 1987Dec;15(12):1140-2. Abstract
Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007 Jun;33(6):951-62. Abstract
de Laet IE, Malbrain M. Current insights in intra-abdominal hypertension and abdominal compartment syndrome. Med Intensiva. 2007 Mar;31(2):88-99. Abstract
Malbrain ML, De Laet I, Cheatham M. Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS): the long road to the final publications, how did we get there? Acta Clin Belg Suppl. 2007;62(Suppl 1):44-59. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Shock
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More DifferentialsGuidelines
- Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines
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