Abdominal Compartment Syndrome

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Abdominal Compartment Syndrome

• Director VS???
• Presentor Ri???

Key words intra-abdominal hypertension,
abdominal compartment syndrome, intra-abdominal
pressure
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Outline

• Definitions
• Pathophysiology
• Diagnosis
• Clinical signs of ACS
• Treatment
• Conclusions

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Definitions

• IAP (intra-abdominal pressure)
• APP (abdominal perfusion pressure)MAP-IAP.
• FG GFP-PTP MAP-2IAP.
• IAP(mmHg)
• end-expiration
• supine position
• No abdominal muscle contractions
• zeroed at midaxillary line.
• via the bladder with a maximal instillation
  volume of 25ml sterile saline.
• Normal IAP approx. 57 mmHg in critically ill
  adults.

Intensive Care Med. 200632(11)1722
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Crit Care Med. 2008 36(4 Suppl)S212
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UpToDate
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Definitions

• IAH (intra-abdominal hypertension) IAP12mmHg.
• grade I, IAP 1215 mmHg
• grade II, IAP 1620 mmHg
• grade III, IAP 2125 mmHg,
• grade IV, IAPgt25mmHg.
• ACS sustained IAPgt20mmHg
• with or without an APP lt 60mmHg
• new organ dysfunction
• Primary ACS injury or disease in the
  abdominopelvis
• Secondary ACS not originate from the
  abdominopelvis
• Recurrent ACS w/ previous treatment of ACS

Intensive Care Med. 200632(11)1722
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Pathophysiology

• Abdominal wall compliance
• Intra-luminal fluid
• Intra-abdominal fluid
• Capillary leak / fluid resuscitation

Intensive Care Med. 2007 33(6)951
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Risk Factors
Intensive Care Med. 2007 33(6)951
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Organ Edema

• Elevated IAP
• Venous congestion
• IAPgt20 reduced perfusion of capillary beds
• Tissue ischemia, inflammatory mediators (lactate,
  adenosine)
• Increased extrvasation
• Increase IAP
• Impaired lymphatic flow

Crit Care Med. 200836(4)1304
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Compromised Respiration

• Cephalad displacement of the diaphragm
• Reduced lung compliance
• Increased positive airway pressure
• Decreased hepatosplanchnic flow
• Compression of the inferior vena cava
• Decreased venous return
• Further increased IAP

Crit Care Med. 200836(4)1304
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Diagnosis

• Patients at risk
• Signs
• Diagnostic measures IAP monitoring

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Patients at risk
Crit Care Med. 200836(4)1304
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Etiology
Crit Care Med. 200836(4)1304
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Clinical signs of ACS

• Increased airway pressure
• Decreased urine output
• Tense abdomen
• Monitoring of IAP

Crit Care Med. 200836(4)1304
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UpToDate
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Intensive Care Med. 2007 33(6)951
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Treatment

• Primary vs secondary ACS
• Medical vs surgical treatments

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Treatment
Intensive Care Med. 2007 33(6)951
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Intensive Care Med. 2007 33(6)951
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Treatment
Curr Opin Crit Care. 2005 11(4)333
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Curr Opin Crit Care. 2005 11(4)333
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UpToDate
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Conclusions
Crit Care Med. 2008 36(6)1823
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Reference

• Crit Care Med. 2008 Jun36(6)1823-31. Incidence
  and clinical effects of intra-abdominal
  hypertension in critically ill patients. Vidal
  MG, Ruiz Weisser J, Gonzalez F, Toro MA, Loudet
  C, Balasini C, Canales H, Reina R, Estenssoro E.
• Intensive Care Med. 2008 Sep34(9)1565-9. AIDS
  is coming to your ICU be prepared for acute
  bowel injury and acute intestinal distress
  syndrome...Malbrain ML, De Laet I.
• Curr Opin Crit Care. 2005 Aug11(4)333-8.
  Abdominal compartment syndrome. Sugrue M.
• Intensive Care Med. 2007 Jun33(6)951-62.
  Results from the International Conference of
  Experts on Intra-abdominal Hypertension and
  Abdominal Compartment Syndrome. II.
  Recommendations. Cheatham ML, Malbrain ML,
  Kirkpatrick A, Sugrue M, Parr M, De Waele J,
  Balogh Z, Leppäniemi A, Olvera C, Ivatury R,
  D'Amours S, Wendon J, Hillman K, Wilmer A.
• Intensive Care Med. 2006 Nov32(11)1722-32.
  Results from the International Conference of
  Experts on Intra-abdominal Hypertension and
  Abdominal Compartment Syndrome. I. Definitions.
  Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue
  M, Parr M, De Waele J, Balogh Z, Leppäniemi A,
  Olvera C, Ivatury R, D'Amours S, Wendon J,
  Hillman K, Johansson K, Kolkman K, Wilmer A.
• Crit Care Med. 2008 Apr36(4)1304-10. Abdominal
  compartment syndrome a concise clinical review.
  An G, West MA.
• Crit Care Med. 2008 Apr36(4 Suppl)S212-5.
  Abdominal compartment syndrome. Maerz L, Kaplan
  LJ.
• UpToDate Online 16.2

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?Thank You?
Key words intra-abdominal hypertension,
abdominal compartment syndrome, intra-abdominal
pressure,abdominal perfusion pressure