Intra-abdominal hypertension and the abdominal compartment syndrome

Schein, Moshe; Ivatury, Rao R.

doi:10.1046/j.1365-2168.1998.00831.x

Cited by 138 publications

(11 citation statements)

References 16 publications

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“…Despite the limitations discussed above, these studies illustrate the importance of early diagnosis and timely abdominal decompression in the management of ACS. The adverse physiological effects of IAH start long before the manifestation of ACS becomes clinically evident [20]. Therefore, the question of appropriate timing for decompression is a pressing issue that remains unclear.…”

Section: Resultsmentioning

confidence: 99%

Abdominal Decompression in Children

Ejike

Mathur

2012

Critical Care Research and Practice

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Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children.

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Section: Resultsmentioning

confidence: 99%

Abdominal Decompression in Children

Ejike

Mathur

2012

Critical Care Research and Practice

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“…Despite the fact that the adverse consequences of excessive IAP had been appreciated by some authors well over 100 years ago [13], the first reported documented occurrence of ACS without a primary inciting abdominal injury was not until 1994, when it was reported by Greenhalgh and Warden in burned children [14]. Since this seminal report, it has become recognized that the larger the thermal injury the greater the incidence of both IAH and ACS.…”

Section: Historical and Epidemiologic Considerationsmentioning

confidence: 99%

Intraabdominal Hypertension and the Abdominal Compartment Syndrome in Burn Patients

et al. 2009

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Severe burns represent a devastating injury that induces profound systemic inflammation requiring large volumes of resuscitative fluids. The consequent massive swelling and peritoneal ascites raises intraabdominal pressures (IAP) to supraphysiologic levels commensurate with intraabdominal hypertension (IAH) and with the abdominal compartment syndrome (ACS) if consistently associated with IAP >20 mmHg and associated with new organ failure. Severe burn injuries are an example of the secondary ACS (secondary ACS), wherein there has been no primary inciting intraperitoneal injury, yet severe IAH/ACS develops, setting the stage for progressive multiorgan dysfunction. These definitions along with practice management guidelines have recently been promulgated by the World Society of the Abdominal Compartment Syndrome (WSACS) in an effort to standardize terminology and communication regarding IAH/ACS in critical care. It is currently unknown whether these syndromes are iatrogenic consequences of excessive or poorly managed fluid resuscitation or unavoidable sequelae of the primary injury. It occurs frequently with burns of >60% body surface area, especially with associated inhalational injury, delayed resuscitation, and abdominal wall injuries. IAH/ACS is often a hyperacute phenomenon that occurs within the first hours of admission and thereafter with any complication requiring aggressive fluid resuscitation. Despite a number of noninvasive management strategies, interventions such as percutaneous peritoneal drainage and, ultimately, decompressive laparotomy are often required once the ACS is established. Whether novel resuscitation strategies can avoid or minimize IAH/ACS is unproven at present and requires further study. Truly understanding postburn ACS may require further insights into the basic mechanisms of injury and resuscitation.

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“…Intra‐abdominal hypertension (IAH) is a clearly identified cause of organ dysfunction in patients who have had emergency abdominal surgery or suffered severe trauma1, 2, 3, 4. It is also being recognized increasingly in various other patients receiving intensive care after elective surgical procedures5, liver transplantation6, massive fluid resuscitation for extra‐abdominal trauma7, severe burns8 and aortic aneurysm repair9, 10.…”

Section: Introductionmentioning

confidence: 99%

Decompressive laparotomy for abdominal compartment syndrome

Waele

Kimball

Malbrain

et al. 2016

British Journal of Surgery

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100

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BackgroundThe effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes.MethodsThis was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28‐day and 1‐year all‐cause mortality. Changes in intra‐abdominal pressure (IAP) and organ function, and laparotomy‐related morbidity were secondary endpoints.ResultsThirty‐three patients were included in the study (20 men). Twenty‐seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20–32). Median IAP was 23 (21–27) mmHg before decompressive laparotomy, decreasing to 12 (9–15), 13 (8–17), 12 (9–15) and 12 (9–14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non‐survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28‐day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non‐survivors were no different from survivors, except that they tended to be older and on mechanical ventilation.ConclusionDecompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome.

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Intra-abdominal hypertension and the abdominal compartment syndrome

Cited by 138 publications

References 16 publications

Abdominal Decompression in Children

Abdominal Decompression in Children

Intraabdominal Hypertension and the Abdominal Compartment Syndrome in Burn Patients

Decompressive laparotomy for abdominal compartment syndrome

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