Abdominal compartment syndrome.

PURPOSE OF REVIEW

This review will set forth the new consensus definitions for intra-abdominal pressure, intra-abdominal hypertension, and the abdominal compartment syndrome from the World Congress on the Abdominal Compartment Syndrome in December 2004. The review will explore the challenges in diagnosis, pathophysiology, and recent concepts in the treatment of abdominal compartment syndrome.

RECENT FINDINGS

Intra-abdominal pressure greater than 12 mm Hg may exert adverse physiologic sequelae, progressing to intra-abdominal hypertension and full-blown abdominal compartment syndrome as intra-abdominal pressure increases. The first challenge is to recognize that abdominal compartment syndrome may be a potential problem in critically ill patients. Intra-abdominal pressure monitoring is essential for this. Continuous monitoring of intra-abdominal pressure and abdominal perfusion pressure adds real-time measurements and can be performed by way of the stomach or bladder. Intra-abdominal hypertension occurs in approximately 35% of patients in the intensive care unit, and abdominal compartment syndrome in approximately 5%.

SUMMARY

Massive resuscitation is increasingly recognized as a major contributor to abdominal compartment syndrome. Prophylactic decompression and temporary abdominal closure have important roles in preventing tertiary or recurrent abdominal compartment syndrome. Failure to recognize and treat intra-abdominal hypertension will result in increased risk of renal impairment, visceral and intestinal ischemia, respiratory failure and death.