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 nonspecific and appear late. Classic 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 intraluminal contents, optimization 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.[1]Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul;39(7):1190-1206. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680657 http://www.ncbi.nlm.nih.gov/pubmed/23673399?tool=bestpractice.com