CONTENTS


rapid reference

(back to contents)


treatment of abdominal compartment syndrome ✅

hemodynamics (more)
decompress the abdomen (more)
decompress the thorax (more)
sedation & paralysis (if intubated) (more)

causes

(back to contents)


The causes of abdominal compartment syndrome are diverse, with many patients having several.  In many cases, the cause may be obvious based on the clinical scenario.  In other situations, CT scan may be helpful to clarify the cause of abdominal distension.

primary abdominal compartment syndrome (intra-abdominal processes)
secondary abdominal compartment syndrome (extra-abdominal causes)
exacerbating factors

epidemiology

(back to contents)


abdominal compartment syndrome is common


physiological relationships between various compartments

(back to contents)


pressure transduction between different compartments
“abdominal compartment syndrome” is a misnomer

physiology & manifestations

(back to contents)


general principles
cardiovascular 
respiratory
renal 
brain:  increased intracranial pressure

diagnosis

(back to contents)


physical examination
abdominal pressure measurement using a Foley catheter
diagnostic criteria for abdominal compartment syndrome

treatment

(back to contents)


There are many treatments of abdominal compartment syndrome other than surgical decompression of the abdomen.  Thus, the inability to perform surgery should not lead to a sense of cynicism about the treatment of this disorder.


hemodynamics

(back to contents)


defend the abdominal perfusion pressure

Abdominal Perfusion Pressure = MAP – (Abdominal Compartment Pressure)

Target MAP > (60 mm + Abdominal Compartment Pressure)

volume removal if possible

decompress the abdomen

(back to contents)


drainage of ascites
removal of gut contents
surgical decompression 

decompress the thorax

(back to contents)


measures to reduce intrathoracic pressure
beware of intubation

sedation & paralysis

(back to contents)


agitation (e.g. bucking the ventilator)
paralysis

podcast

(back to contents)


Follow us on iTunes

The Podcast Episode

Want to Download the Episode?
Right Click Here and Choose Save-As


questions & discussion

(back to contents)


To keep this page small and fast, questions & discussion about this post can be found on another page here.

Guide to emoji hyperlinks 🔗

Going further

References

  • 11038078  Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma. 2000 Oct;49(4):621-6; discussion 626-7. doi: 10.1097/00005373-200010000-00008  [PubMed]
  • 12297912  Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M, Stewart A, Hillman K, Deane SA. Clinical examination is an inaccurate predictor of intra-abdominal pressure. World J Surg. 2002 Dec;26(12):1428-31. doi: 10.1007/s00268-002-6411-8  [PubMed]
  • 12799335  Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Valdivia A, Sailors RM, Moore FA. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg. 2003 Jun;138(6):637-42; discussion 642-3. doi: 10.1001/archsurg.138.6.637  [PubMed]
  • 17895487  Daugherty EL, Hongyan Liang, Taichman D, Hansen-Flaschen J, Fuchs BD. Abdominal compartment syndrome is common in medical intensive care unit patients receiving large-volume resuscitation. J Intensive Care Med. 2007 Sep-Oct;22(5):294-9. doi: 10.1177/0885066607305247  [PubMed]
  • 21903735  Cheatham ML, Safcsak K. Percutaneous catheter decompression in the treatment of elevated intra-abdominal pressure. Chest. 2011 Dec;140(6):1428-1435. doi: 10.1378/chest.10-2789  [PubMed]
  • 24280691  Ortiz-Diaz E, Lan CK. Intra-abdominal hypertension in medical critically ill patients: a narrative review. Shock. 2014 Mar;41(3):175-80. doi: 10.1097/SHK.0000000000000100  [PubMed]
  • 25421925  Regli A, De Keulenaer B, De Laet I, Roberts D, Dabrowski W, Malbrain ML. Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension. Anaesthesiol Intensive Ther. 2015;47(1):45-53. doi: 10.5603/AIT.a2014.0067  [PubMed]
  • 26309180  Anvari E, Nantsupawat N, Gard R, Raj R, Nugent K. Bladder Pressure Measurements in Patients Admitted to a Medical Intensive Care Unit. Am J Med Sci. 2015 Sep;350(3):181-5. doi: 10.1097/MAJ.0000000000000543  [PubMed]
  • 27016163  Maluso P, Olson J, Sarani B. Abdominal Compartment Hypertension and Abdominal Compartment Syndrome. Crit Care Clin. 2016 Apr;32(2):213-22. doi: 10.1016/j.ccc.2015.12.001  [PubMed]
  • 30454823  Sosa G, Gandham N, Landeras V, Calimag AP, Lerma E. Abdominal compartment syndrome. Dis Mon. 2019 Jan;65(1):5-19. doi: 10.1016/j.disamonth.2018.04.003  [PubMed]
  • 31524716  Pereira BM. Abdominal compartment syndrome and intra-abdominal hypertension. Curr Opin Crit Care. 2019 Dec;25(6):688-696. doi: 10.1097/MCC.0000000000000665  [PubMed]
  • 32004192  Allen R, Sarani B. Evaluation and management of intra-abdominal hypertension. Curr Opin Crit Care. 2020 Apr;26(2):192-196. doi: 10.1097/MCC.0000000000000701  [PubMed]
  • 32204721  De Laet IE, Malbrain MLNG, De Waele JJ. A Clinician's Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care. 2020 Mar 24;24(1):97. doi: 10.1186/s13054-020-2782-1  [PubMed]
  • 33480617  Kimball EJ. Intra-abdominal hypertension and abdominal compartment syndrome: a current review. Curr Opin Crit Care. 2021 Apr 1;27(2):164-168. doi: 10.1097/MCC.0000000000000797  [PubMed]