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 intra-abdominal pressure (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) 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