Abdominal Compartment Syndrome

Abdominal Compartment Syndrome: Toward Less-Invasive Management

Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms

Bladder pressure measurements (BPMs) are considered a key component in the diagnosis of abdominal compartment syndrome (ACS). The purpose of this observational review was to determine risk factors of ACS and associated mortality with particular focus on the role of BPM. A retrospective trauma registry and chart review was performed on trauma patients from January 2003 through December 2010. Comparisons were made between patients with and without ACS. There were 3172 patients included in the study of whom 46 had ACS. Patients with ACS were younger, more severely injured, with longer lengths of stay. Logistic regression determined Injury Severity Score (ISS) and urinary catheter days as independent predictors of ACS, whereas independent predictors of mortality included age, ISS, and ACS. Subset analysis demonstrated no association between BPM 20 mmHg or greater and diagnosis of ACS versus no ACS. Logistic regression indicated independent predictors of mortality were number of BPM 20 mmHg or greater and age. Patients with ACS are more severely injured with worse outcomes. An isolated BPM 20 mmHg or greater was not associated with ACS and may be inadequate to independently diagnose ACS. These findings suggest the need for repeat measurements with early intervention if they remain elevated in an effort to decrease mortality associated with ACS.

An elevation in intra-abdominal pressure is the clinical condition referred as abdominal compartment syndrome (ACS). The prevalence varies depending on the patient characteristics considered, exponentially rising in life-threatening situations such as trauma, shock and burn patients. The syndrome can also occur after surgical operations like abdominal organ transplantation, post-transplant kidney syndrome among various others. All physiological systems, but particularly the cardiovascular, respiratory, renal, and neurological systems, are impacted by ACS. Blood flow to numerous organs is influenced by ACS and intra-abdominal hypertension. Recognizing and identifying ACS, its risk factors, and clinical symptoms can help to lower the associated morbidity and mortality. The purpose of this research is to review the available information about ACS: risk factors, complications and treatment. ACS is a fatal condition if not diagnosed and treated timely. Patients who have undergone extensive abdominal surgery, experienced septic issues, received intensive fluid replacement, sustained abdominal trauma are at an increased risk of developing ACS. Multiple-organ failure, prolonged recovery, acute kidney injury, low cardiac output, elevated cranial pressure and respiratory distress are the complications of ACS. ACS can occur regardless of the primary diagnosis or treating medical speciality. Surgical decompression, vascular volume replacement, prokinetic drugs, efficient curarization, and percutaneous drainage of large-volume ascites are the treatment strategies for ACS. Combining the underlying disease's therapy approach, patient stabilization, and ACS management is necessary to establish the best course of care. Early detection of ACS is essential for management and the treatment of the patients.

Open repair of ruptured abdominal aortic aneurysms (rAAA) has been increasingly replaced by endovascular aortic repair (EVAR) in many centers. Despite being a minimally invasive procedure, EVAR is associated with a risk of abdominal compartment syndrome (ACS), which can lead to significant morbidity and mortality. This study examines the incidence and clinical manifestation of ACS in a consecutive cohort of rAAA patients treated exclusively with EVAR at Örebro University Hospital over a 12-year period. This is a retrospective analysis of prospectively collected data. We identified 139 patients who had presented to Örebro University Hospital with rAAA between October 2009 and September 2021. Patients with isolated iliac artery, thoracic and thoracoabdominal aortic ruptures, previous aortic interventions (open or endovascular), and patients receiving palliative treatment were excluded. Patients developing ACS after rAAA were compared with those who did not develop ACS. A total of 100 patients treated using EVAR were included in this study. ACS was identified in 17 patients, and these were compared with 83 patients who did not develop ACS. Mortality at 30 days was 53% in the ACS group (9/17) and 22% in the No-ACS group (18/83, p = 0.015). Regression analysis showed that advanced age and ACS were independent risk factors for death, with ACS increasing the hazard 4-fold (HR 4.26, CI 1.99-9.10, p < 0.001) and age increasing the hazard by 6% for every year (HR 1.06, CI 1.06-1.1, p = 0.004). The use of aortic balloon occlusion was not independently associated with the development of ACS. ACS is a life-threatening complication of rAAA treated using EVAR and a significant number of patients developed ACS with high mortality and complication rates. All rAAA patients treated using EVAR should be monitored closely for ACS and treatment with decompressive laparotomy should be initiated without delay.Clinical ImpactOpen repair of ruptured abdominal aortic aneurysms (rAAA) has been increasingly replaced by endovascular aortic repair (EVAR). Despite being a minimally invasive procedure, EVAR is associated with a risk of abdominal compartment syndrome (ACS), which can lead to significant morbidity and mortality This article investigates abdominal compartment syndrome (ACS) in a cohort of total endovascular treated rAAA in a single centre and the treatment as well as the results, and gives insight on ACS in this patient group and might contribute to better understanding how to treat them and avoid this life-threatening complication.

SUN-PP061: Gut Dysfunction in Abdominal Compartment Syndrome during Severe Acute Pancreatitis and Dilemmas in Nutritional Support

Traumatic abdominal compartment syndrome (ACS) can result from a blunt or penetrating trauma which involves abdominal and pelvic cavity. A direct injury to the abdomen or pelvis can cause vascular, tissue, and organ injuries which are frequently associated with ongoing hemorrhage. The severe bleeding causes hypoperfusion to organs and tissues, whereas the collection of blood within the abdominal and pelvic cavity can cause intra-abdominal hypertension (IAH). Both conditions can result in tissue and organ hypoxia. Traumatic ACS is diagnosed when the intra-abdominal pressure is greater than 20 mmHg, with the development of single- or multiple-organ dysfunction. In the acute setting of a severely injured patient, it is mandatory to control bleeding and restore coagulation function. Many patients need massive fluid resuscitation and are treated with abdominal packing. In presence of life-threatening hemorrhage, these treatments are necessary, but these same factors also increase the risk of developing ACS. Traumatic ACS is a clinical syndrome which may easily be misinterpreted, and can lead to worsening of patient outcome. It is essential to diagnose and manage ACS early, because without a rapid intervention the risk of death is high. It is considered a complication that is potentially reversible. Abdominal decompression of ACS rapidly improves cardiac, pulmonary, and renal functioning. With the use of multi-detector computed tomography (MDCT) for the assessment and follow-up of severe blunt and penetrating injuries, an unsuspected ACS can be diagnosed early, before the development of severe organ or multi-organ dysfunction. CT can provide evidence of some indicative features of increased intra-abdominal pressure in patients at risk for developing ACS, including large hematomas. The partnership between the radiologist and surgeon to utilize both clinical and CT findings to detect early ACS provides a more precise method for the detection and rapid treatment of this lethal but potentially reversible syndrome. Radiologists could be increasingly likely to evaluate patients with ACS in the presence of abdominal and/or pelvic hemorrhage and/or postsurgical application of packs. Correct early radiological diagnosis of ACS is based on the knowledge of the MDCT findings, as well as awareness of the pathophysiology of the syndrome.

Abdominal Compartment Syndrome After Surgery for Abdominal Aortic Aneurysm: A Nationwide Population Based Study

Multiple methods exist to manage in the intensive care unit the patient with an open abdomen. An increasingly common method is the vacuum packed technique. This method accommodates considerable expansion of intra-abdominal contents and should obviate the potential development of the abdominal compartment syndrome (ACS). Despite this, some patients with these temporary abdominal dressings will go on to develop ACS. For the purpose of this study we have defined this clinical entity as the open abdomen ACS. Patients with an open abdomen who develop ACS have a poor prognosis. Fluid requirements and resuscitative indices may predict which of these patients will develop open abdomen ACS. A retrospective review was performed of patients with trauma who had an open abdomen treated with vacuum packed dressings at our urban level I trauma center. Over 1 year (July 1, 1999-June 30, 2000), 5 patients managed with an open abdomen developed ACS. These patients were compared with 15 consecutive patients with an open abdomen who did not develop clinical ACS during that same period. Fluid resuscitation, base deficit, pH, lactate level, systolic blood pressure, prothrombin time, temperature, peak inspiratory pressure, and PCO(2) were abstracted. The Fisher exact test was used for statistical analysis. In patients managed with an open abdomen, ACS developed between 1.5 and 12 hours (mean [SD], 7.5 [3.9] hours) after placement of the vacuum packed dressing. The base deficit, pH, peak inspiratory pressure, PCO(2,) and lactate level were more abnormal and the crystalloid requirements were significantly higher in the ACS group. The systolic blood pressure, temperature, and prothrombin time did not differ between groups. Three patients with ACS developed a second episode of ACS. Mortality in the ACS group was 3 (60%) of 5 patients vs 1 (7%) of 15 patients in the control group. Management of the open abdomen with the temporary abdominal closure does not prevent the development of ACS. Mortality is high when ACS occurs in this scenario. Severe physiologic derangement and high crystalloid requirements may predict which patients will develop ACS.

Editor's Choice – Abdominal Compartment Syndrome After Surgery for Abdominal Aortic Aneurysm: A Nationwide Population Based Study

Derivation and Validation of a Risk Score for Abdominal Compartment Syndrome after Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms

How to identify patients at risk of abdominal compartment syndrome after surgical repair of ruptured abdominal aortic aneurysms in the operating room: A pilot study

A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms

No. 349 - Which dose abdominal compartment syndrome occur after endovascular repair of ruptured infra-renal abdominal aortic aneurysm or not?

Intra-abdominal hypertension has been recognized as a source of morbidity and mortality in the traumatized patient following laparotomy. Multiple organ dysfunction attributable to intra-abdominal hypertension has been called the abdominal compartment syndrome. The epidemiology and characteristics of these processes remain poorly defined. Intra-abdominal pressure was measured prospectively in all patients admitted to a trauma intensive care unit over 9 months. Data were gathered on all patients with intra-abdominal hypertension. Some 706 patients were evaluated. Fifteen (2 per cent) of 706 patients had intra-abdominal hypertension. Six of the 15 patients with intra-abdominal hypertension had abdominal compartment syndrome. Half of the patients with abdominal compartment syndrome died, as did two of the remaining nine patients with intra-abdominal hypertension. Patients with abdominal compartment syndrome had a mean intra-abdominal pressure of 42 mmHg compared with 26 mmHg in patients with intra-abdominal hypertension only (P < 0.05). The incidence of intra-abdominal hypertension and abdominal compartment syndrome was 2 and 1 per cent respectively. Intra-abdominal hypertension did not necessarily lead to abdominal compartment syndrome, and often resolved without clinical sequelae. Abdominal compartment syndrome did not occur in the absence of earlier laparotomy. Abdominal compartment syndrome was associated with a marked increase in intra-abdominal pressure (above 40 mmHg).