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.
History and exam
Key diagnostic 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 hematoma
1st investigations to order
- transbladder measurement of intra-abdominal pressure
- oxygen saturation
- BUN 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
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.
Bart De Keulenaer, MD, FJFICM
BDK declares that he has no competing interests.
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