Abstract
IntroductionAbdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intraabdominal pressure (IAP) are well documented. Surgical decompression through a midline laparotomy or decompressive laparotomy remains the sole definite therapy for ACS, but the effect of decompressive laparotomy has not been studied in large patient series.MethodsWe reviewed English literature from 1972 to 2004 for studies reporting the effects of decompressive laparotomy in patients with ACS. The effect of decompressive laparotomy on IAP, patient outcome and physiology were analysed.ResultsEighteen studies including 250 patients who underwent decompressive laparotomy could be included in the analysis. IAP was significantly lower after decompression (15.5 mmHg versus 34.6 mmHg before, p < 0.001), but intraabdominal hypertension persisted in the majority of the patients. Mortality in the whole group was 49.2% (123/250). The effect of decompressive laparotomy on organ function was not uniform, and in some studies no effect on organ function was found. Increased PaO2/FIO2 ratio (PaO2 = partial pressure of oxygen in arterial blood, FiO2 = fraction of inspired oxygen) and urinary output were the most pronounced effects of decompressive laparotomy.ConclusionThe effects of decompressive laparotomy have been poorly investigated, and only a small number of studies report its effect on parameters of organ function. Although IAP is consistently lower after decompression, mortality remains considerable. Recuperation of organ dysfunction after decompressive laparotomy for ACS is variable.
Highlights
Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intraabdominal pressure (IAP) are well documented
The effects of decompressive laparotomy have been poorly investigated, and only a small number of studies report its effect on parameters of organ function
The goal of this review is to describe the effect of surgical decompression through a midline laparotomy (termed 'decompressive laparotomy' (DL) in this review) on intraabdominal pressure (IAP) and the outcome and physiology of patients undergoing this procedure
Summary
Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intraabdominal pressure (IAP) are well documented. Intraabdominal hypertension (IAH) is a clearly identified cause of organ dysfunction in patients after emergency abdominal surgery and trauma [1,2,3]. It is increasingly recognized in other patients in the intensive care unit (ICU), for example, after elective surgical procedures [4], liver transplantation [5], massive fluid resuscitation for extraabdominal trauma [6] and severe burns [7]. Other proposed therapies include ultrafiltration [12] and the use of muscular blocking agents [13]
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