The Reply:

Abstract

In the December 2001 issue of the American Journal of Surgery we reported our experience with the abdominal compartment syndrome (ACS) in patients who had undergone damage control surgery for trauma [ [1] Raeburn C.D. Moore E.E. Biffl W.L. et al. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001; 182: 542-546 Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar ] and in patients without intraabdominal injuries who require extensive resuscitation for protracted shock (secondary ACS) [ [2] Biffl W.L. Moore E.E. Burch J.M. et al. Secondary abdominal compartment syndrome is a highly lethal event. Am J Surg. 2001; 182: 645-648 Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar ]. Perhaps more importantly, we [ 1 Raeburn C.D. Moore E.E. Biffl W.L. et al. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001; 182: 542-546 Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar , 3 Meldrum D.R. Moore F.A. Moore E.E. et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997; 174: 667-673 Abstract Full Text PDF PubMed Scopus (360) Google Scholar ] and others [ [4] Ivatury R.R. Porter J.M. Simon R.J. et al. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma. 1998; 44: 1016-1023 Crossref PubMed Scopus (306) Google Scholar ] have observed an increase in the incidence of multiple organ failure (MOF) in patients who develop ACS. While it is unclear whether this relationship is one of cause or effect, we believe that the ACS contributes to the development of MOF. In fact, we have devised animal models that support these clinical observations [ 5 Rezende-Neto J. Moore E.E. Masuno T. et al. The abdominal compartment syndrome as a second insult during systemic neutrophil priming provokes acute lung injury. Shock. 2002; (In press) Google Scholar , 6 Rezende-Neto J. Moore E.E. Andrade M.U. et al. Systemic inflammatory response to intra-abdominal hypertension setting the stage for multiple organ failure. J Trauma. 2002; (In press) PubMed Google Scholar ]. Thus, strategies that prevent the development of ACS should reduce the incidence of MOF.