Abstract

Abdominal compartment syndrome and intra-abdominal hypertension (IAH) has been widely studied in surgical and trauma patients, even though the incidence of IAH in medical intensive care unit (MICU) remains high. Studies have shown that the time to decision making regarding diagnosis and management of IAH is twice in MICU compared to the corresponding surgical side. MICU patients often require large volume resuscitation such as in sepsis, hemorrhage, or an inflammatory condition such as acute pancreatitis, which increases the risk of development of IAH. It is often underdiagnosed and undertreated in MICU due to a lack of awareness of the consequences and mortality associated with it. Elevated intra-abdominal pressure has systemic effects causing atelectatic lungs, decreased cardiac output, and renal insufficiency. IAH, if not recognized early, can quickly progress to compartment syndrome causing multiorgan failure and death. Approach to ACS management between medical and surgical intensivists varies largely because of lack of experience with surgical decompression. This article provides an overview of definitions, incidence, pathophysiology, clinical presentation, diagnosis, and management of IAH and abdominal compartment syndrome in critically in medical patients.

Highlights

  • A progressive increase in intra-abdominal pressure initially results in intraabdominal hypertension and later, affects end-organ perfusion resulting in abdominal compartment syndrome

  • Subacute Intra-abdominal hypertension (IAH) refers to the elevation of Intra-abdominal pressure (IAP) over days and is mostly seen in the medical intensive care unit (MICU) patients receiving large volume resuscitation and has potential to progress to Abdominal compartment syndrome (ACS)

  • An incidence study done on MICU patients receiving large-volume resuscitation showed that 85% of patients enrolled developed IAH with IAP > 12 mmHg, 33% developed IAP > 20 mmHg and 25% met the criteria for ACS

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Summary

Introduction

A progressive increase in intra-abdominal pressure initially results in intraabdominal hypertension and later, affects end-organ perfusion resulting in abdominal compartment syndrome. It is often under-diagnosed as the end-organ perfusion caused by intra-abdominal hypertension in this patient population can be explained by their overall critical condition. Clinicians must have a high suspicion for intra-abdominal hypertension to prevent it from progressing to compartment syndrome and death

Intra-abdominal pressure
Abdominal perfusion pressure (APP)
Intra-abdominal hypertension (IAH)
Filtration gradient (FG)
Abdominal compartment syndrome (ACS)
Incidence
Etiology
Pathophysiology
Cardiovascular
Pulmonary
Gastrointestinal system
Hepatic
Central nervous system
Abdominal wall
Clinical presentation
Signs of abdominal compartment syndrome
Imaging findings
IAP measurement
Intravesical pressure
Intra-gastric pressure
Inferior vena cava pressure
Management
Surgical management
Prognosis
Findings
10. Conclusion
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