Hipertensión intraabdominal y síndrome compartimental abdominal

Abstract

Although intraabdominal pressure (IAP) has been studied for more than 100 years, the concepts of intraabdominal hypertension (IAH) and abdominal compartmental syndrome (ACS) have only been developed as clinical entities of interest in intensive care in the last 5 years. At the first Congress on Abdominal Compartment Syndrome in December 2004, a series of definitions were established, which were published in 2006. IAH is defined as IAP ≥ 12 mmHg and is classified in four severity grades, the maximum grade being ACS, with the development of multiorgan failure. The incidence of IAH in patients in intensive care units is high, around 30% at admission and 64% in those with a length of stay of 7 days. The increase in IAP leads to reduced vascular flow to the splenic organs, increased intrathoracic pressure and decreased venous return, with a substantial reduction in cardiac output. If IAH persists, these physiopathologic episodes are followed by the development of multiorgan failure with renal, cardiocirculatory and respiratory failure and intestinal ischemia. Mortality from untreated ACS is higher than 60%. The only treatment for ACS is surgical decompression. In patients with moderate IAH, medical treatment should be optimized, based on the following measures: a) serial IAP monitoring; b) optimization of systemic perfusion and the function of the distinct systems in patients with high IAP; c) instauration of specific measures to decrease IAP; and d) early surgical decompression for refractory IAH. The application of the medical measures that can reduce IAP and early abdominal decompression in ACS improve survival in critically ill patients with IAH.