Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Abstract

Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

Changes in Microcirculation Due to Intra-Abdominal Hypertension in Surgery

“…применение эндоскопических методик связано с развитием феномена интраабдоминальной гипертензии (иаГ), который встречается также при многих патологических процессах в брюшной полости, таких как перитонит, панкреонекроз, сепсис и др. [1,2,3,4,5,6]. одним из серьезных осложнений, возникающих на фоне иаГ, является расстройство гемодинамики, а также нарушения системы гемостаза, ведущие к возникновению тромбозов и тромбоэмболий.…”

“…клиническая картина синдрома иаГ полиморфна. в зависимости от конкретной органной дисфункции, чаще характеризуется развитием гиповолемии, неустойчивой гемодинамикой, снижением сатурации, явлениями дыхательной недостаточности, олигоурией, нарушениями сознания [2,3]. вышеперечисленные патологические признаки в совокупности могут расцениваться как пон, вызванная различными причинами.…”

Effect of pneumoperitoneum on microcirculation

“…Данные изменения происходят вследствие увеличения давления в брюшной полости, снижения венозного оттока от нижних конечностей, ограничения экскурсии диафрагмы. Кроме того, на организм влияют вещества, входящие в состав инсуффлируемого газа (CO 2 , N 2 O) [2][3][4][5][6][7]. Операционная травма в сочетании с высоким внутрибрюшным давлением может привести к дисфункции эндотелия, нарушениям сосудисто-тромбоцитарного гемостаза и микроциркуляции [8][9][10][11].…”