Abdominal compartment syndrome: Incidence and prognostic factors influencing survival in Singapore.

Abstract

Aim of Study:Abdominal compartment syndrome (ACS) is a distinct clinical entity in the critically ill-patient, which leads to end-organ dysfunction. However, data on the incidence of ACS is scarce, and this is also likely contributed by under-diagnosis of this clinical condition. This study reports all cases of ACS in a tertiary institution in Singapore over 10 years, and evaluates prognostic factors affecting survival.Materials and Methods:This retrospective clinical study included 17 patients with ACS, of which 13 underwent decompressive laparotomy, over a 10 years period. Univariate and multivariate analyses of prognostic factors predicting mortality was performed using Chi-square or Fisher-exact test as appropriate.Results:Mean arterial pressure was significantly improved postoperatively, and intra-abdominal pressure and positive end-expiratory pressure significantly decreased. Overall mortality was 47.1%. Advanced age of more than 65 years, gender, large volume resuscitation of more than 3.5 L over 24 h, three or more co-morbidities, requirement of inotropes, usage of mechanical ventilation, and the presence of concurrent lung and renal dysfunction were not adverse prognostic indicators of poorer outcome. The occurrence of multiple relook laparotomies was shown to be the only independent prognostic factor predicting a favorable outcome among these patients on univariate and multivariate analyses. The incidence of ACS accounts for only 0.1% of all Intensive Care Unit admissions during the study period of 10 years, likely due to under-diagnosis.Conclusion:We believe that a protocol for a focused measurement in high-risk groups will increase the diagnostic yield of this condition. Multiple laparotomies for abdominal decompression can lead to improved survival.