Predictors of exploration in patients at high risk of abdominal compartment syndrome

Abstract

Context Abdominal compartment syndrome (ACS) is caused when an acute increase in intra-abdominal pressure (IAP) occurs sufficient to impair vascular inflow and thereby compromising the viability of the tissues and organs within the abdomen. Familiarity with the presentation of ACS is mandatory for all clinicians who care for critically ill patients to avoid its high mortality if not recognized and treated. The measurement of IAP is a vital part of clinical management of ACS. Early recognition is important, and the need for surgical decompression may be urgent. Aim The aim was to evaluate the cases at high risk for development of ACS trying to prevent its fatal adverse effects by defining its predictors. Patients and methods This prospective, interventional, non-randomized clinical trial was conducted at Mansoura University and emergency hospitals over the period from February 2016 to February 2019. This study was conducted on patients at high risk of intra-abdominal hypertension. Two groups were included. The first group was managed conservatively, and the second one received decompressive laparotomy depending on clinical parameters, including IAP, and general status. Data were analyzed using SPSS v-24. Results A total of 40 patients who had an increased IAP greater than or equal to 20 cmH2O with several clinical presentations were included. These patients had respiratory distress (90%) and distended tense abdomen, whereas abdominal pain and oliguria were only present in ∼25% of cases. Overall, 20 (50%) patients underwent conservative management, and all these cases passed normally. Moreover, 20 (50%) patients underwent decompressive laparotomy. Univariate and multivariate analyses showed central venous pressure, BMI, urinary bladder pressure, and postoperative organ failure were found to be significant independent risk factors that increased the rate of mortality. The complications of the first group were owing to the primary operation and those of the second of group were owing to the primary operation as well as owing to operative decompression procedure. The mortality of the studied groups was 25% in the second one only, and there was a significant difference between both groups in the hospital stay. Conclusion These results had suggested that early detection of cases with ACS and proper management may be curative, and they could decrease multiorgan dysfunction and mortality in such cases. The avoidance of early abdominal closure, which may be distressing to the patients, could be mandatory in such conditions.