Understanding abdominal compartment syndrome
ABSTRACT
Abdominal compartment syndrome, organ dysfunction caused by intra-abdominal hypertension (IAH), carries a mortality of 40% to 100%.1 This article describes abdominal compartment syndrome and how to recognize and respond to it.In most critically ill adults, normal intra-abdominal pressure (IAP, the pressure in the abdominal cavity) is 5 to 7 mm Hg.2 IAH is defined as IAP of 12 mm Hg or more; abdominal compartment syndrome is a sustained IAP of 20 mm Hg or more, with or without an abdominal perfusion pressure of less than 60 mm Hg and new organ dysfunction or failure.3Primary abdominal compartment syndrome results from direct injury to the abdomen or pelvic region such as in cases of blunt or penetrating trauma or ruptured abdominal aortic aneurysm.2 Early surgical or interventional radiologic treatment often is needed for this condition.Secondary abdominal compartment syndrome doesn't originate from the abdominopelvic region; for example, this condition can occur in patients with severe shock who required massive fluid loading due to hemorrhage, sepsis, capillary leak, or major burns.2,4Risk factors for abdominal compartment syndrome include trauma; burns; liver transplantation; abdominal conditions such as massive ascites, abdominal surgery, or intraperitoneal bleeding (which raise IAP); retroperitoneal conditions such as a ruptured abdominal aortic aneurysm, bleeding from a pelvic fracture, and pancreatitis; and surgeries or illnesses such as sepsis that require large-volume fluid replacement.3The gastrointestinal, hepatic, cardiovascular, respiratory, renal, and central nervous systems can be affected by abdominal compartment syndrome.4 * Gastrointestinal-decreased abdominal perfusion pressure, decreased perfusion to abdominal organs, bacterial translocation, multiple organ failure, and low tolerance to enteral feeding.4 * Hepatic-jaundice, increased serum liver enzymes, and coagulopathy can occur as pressure increases and hepatic arterial flow decreases.4 * Cardiovascular-tachycardia.
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