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.
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
- Acute tubular necrosis
- Acute renal failure
- Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines
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