Abdominal Compartment Syndrome
ACS is often overlooked. Diagnosis requires a high index of suspicion due to underlying disease (bowel ischemia) or who requires extensive fluid resuscitation (severe pancreatitis, sepsis, major burns) - Mark Ramsey DO & Nick Mark MD
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Under Pressure: Abdominal Compartment Syndrome
Because ACS often occurs in patients who are critically ill and unable to communicate, it becomes extremely important to understand and identify early warning signs of IAH. The three cardinal signs of ACS are worsening abdominal distension, difficulty breathing or elevated peak pressures on the ventilator, and decreased urine output. Other clinical signs include mental confusion, worsening hypoxia, hypotension, tachycardia, and jugular venous distention.
Measurement of the IAP is needed for definitive diagnosis, and the gold standard is measurement of bladder pressure using a Foley catheter and a transducer or manometer. Remember, ACS is not a diagnosis made on computed tomography (CT)…
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Intra-Abdominal Pressure Monitor
Can be performed using proprietary devices, requires pressure transducer set up connected to indwelling urinary catheter.
"Abdominal compartment syndrome” is a misnomer
Abdominal compartment syndrome can cause failure of numerous (heart, lungs, kidneys, brain). In severe cases, this promotes a vicious spiral of multiorgan failure (e.g., when failure of the heart causes worsening failure of the kidneys). Indeed, it's likely that abdominal compartment syndrome is an occult driver of multiorgan failure among many critically ill patients.
Abdominal Compartment Syndrome
There are no clear values for intraabdominal hypertension or compartment syndrome in children.
Abdominal Compartment Syndrome: Pearls & Pitfalls
Abdominal compartment syndrome (ACS) is defined by sustained intra-abdominal pressure (IAP) > 20 mm Hg with associated organ injury. The condition was first described in 1863, but not significantly discussed until the 1990s.
Articles of Interest
Abdominal compartment syndrome
In December 2004, World Congress on the Abdominal Compartment Syndrome was held, with 170 leaders from around the world setting the stage for future understanding of this complex evolving physiologic phenomenon. Here are the consensus definitions from the meeting...
Annals of B-Pod: Abdominal Compartment Syndrome
Abdominal compartment syndrome is a rare but likely under-recognized clinical condition. Defined as intra-abdominal pressure greater than 20 mmHg with associated end-organ damage, abdominal compartment syndrome can be seen after recent surgery or due to any number of intra-abdominal pathologies.
Failure to Diagnose Abdominal Compartment Syndrome
The sensitivity of both clinical judgment and physical examination have been demonstrated to be very poor in predicting a patient’s IAP.
Management of Abdominal Compartment Syndrome in Acute Pancreatitis
The incidence of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP) is high (60-80% depending on the population studied). It is typically an early phenomenon, and caused by the inflammatory process in the pancreas as well as ascites, ileus, and aggravated by fluid resuscitation. Deterioration to full-blown abdominal compartment syndrome (ACS), has been reported in about 1 out 3 patients with IAH.
Resources
American Journal of Roentgenology
Compartment syndrome is well known in the extremities, where increased pressure within a closed fascial space depresses capillary perfusion pressure to a level that cannot maintain tissue viability. The effects of elevated intraabdominal pressure are less well recognized. Normally, the abdominal pressure is about 5 mm Hg. The intraabdominal pressure may increase with acute and substantial accumulation of fluid within the abdomen. “Abdominal compartment syndrome” is defined as intraabdominal pressure of at least 20 mm Hg with dysfunction of at least one thoracoabdominal organ.
CrashingPatient.com
Hold foley tubing straight up from symphysis pubis, height of urine column is the pressure. If there is no urine, instill 100 cc of saline. Comparable accuracy to other standard techniques.
Deranged Physiology
Abdominal compartment syndrome is a complication of torso trauma and abdominal catastrophe...
Life in the Fastlane
Gold standard is measurement of intra-vesical pressure...
Open Anesthesia
Abdominal compartment syndrome (ACS) is a potentially life-threatening illness that results from the persistent and pathological elevation of IAP above 20mmHg that is associated with new organ dysfunction.
Radiopaedia
Abdominal compartment syndrome is a disease defined by the presence of new end-organ dysfunction secondary to elevated intra-abdominal pressure. Radiological diagnosis is difficult and usually suggested when a collection of imaging findings are present in the appropriate clinical setting or if the signs on sequential imaging studies are seen to progress. Diagnosis is usually clinically supported by elevated intravesicular pressure which closely parallels intra-abdominal compartment pressure.
StatPearls
ACS is usually only observed in critically ill patients and is more frequently diagnosed in the intensive care unit (ICU) than in the emergency department. Of note, physical examination is not a reliable indicator of ACS, even when performed by experienced clinicians,
