Abdominal Compartment Syndrome By elham rabiee آموزش گروه جراحی مرکز آموزشی درمانی ولایت

Abdominal compartment syndrome refers to organ dysfunction caused by intraabdominal hypertension. Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are distinct clinical entities and should not be used interchangeably.

intra-abdominal pressure(IAP) :This is the pressure within the abdominal cavity,5 – 7 mmHg is normal in a critically ill adult.  Intraabdominal hypertension (IAH): is defined as a sustained intraabdominal pressure ≥12 mmHg

Classify IAH into 4 groups: Hyper acute IAH: laughing, coughing, straining, sneezing, defecation, or physical activity. Acute IAH: trauma or intraabdominal hemorrhage. Subacute IAH:medical patients Chronic IAH:pregnancy

Abdominal compartment syndrome:is defined as a sustained intraabdominal pressure >20 mmHg that is associated with new organ dysfunction.

EPIDEMIOLOGY Most studies evaluating the incidence of ACS were done in trauma patients, with estimates of incidence varying considerably.

Common Causes of ACS Trauma Burns Liver transplantation Abdominal conditions(Massive ascites, bowel distension, abdominal surgery, or intraperitoneal bleeding) Post-surgical patients

Pathophysiological Consequences of ACS Cardiovascular: Impaired cardiac function Reduced venous return

Pulmonary Reduced lung compliance secondary to diaphragmatic elevation Hypoventilation Increased work of breathing Hypoxia and hypercarbia Mechanical ventilation often required

Renal Increased IAH leads to decreased renal blood flow Oliguria may be observed with IAP of 15 - 20 An IAP of >30 leads to anuria

Gastrointestinal: Mesenteric blood flow was reduced Intestinal ischemia

Central Nervous System: Decreased cerebral outflow of blood Increased intracranial pressure

CLINICAL PRESENTATION Symptoms:The rare patient who is able to convey symptoms may complain of malaise, weakness, lightheadedness, dyspnea,abdominal pain. Physical signs:distended abdomen, Progressive oliguria,hypotension, tachycardia, an elevated jugular venous pressure, peripheral edema, abdominal tenderness.

DIAGNOSTIC EVALUATION Measurement of intraabdominal pressure The drainage tube of the patient's Foley (bladder) catheter is clamped. Sterile saline (up to 60 mL) is instilled into the bladder via the aspiration port of the Foley catheter and the catheter filled with fluid. An 18-gauge needle attached to a pressure transducer is inserted into the aspiration port. With some newer style Foley catheters, this can be done using a needle-less connection system. The pressure is measured at end-expiration in the supine position after ensuring that abdominal muscle contractions are absent. The transducer should be zeroed at the level of the midaxillary line.

SUPPORTIVE MANAGEMENT Ventilatory support Hemodynamic support

SURGICAL DECOMPRESSION Surgical decompression for all patients whose intraabdominal pressure is greater than 25 mmHg Many clinicians suggest surgical decompression at a lower intraabdominal pressure (eg, 15 to 25 mmHg) Other clinicians believe that the need for surgical decompression should be determined by the abdominal perfusion pressure (APP)

MORBIDITY AND MORTALITY  Failure to recognize IAH prior to the development of ACS causes tissue hypoperfusion, which may lead to multisystem organ failure, and potentially death. Mortality estimates for patients with ACS range from 40 to 100 percent.

Evaluation of the relationship between pelvic fracture and abdominal compartment syndrome in traumatic patients

Materials and Methods: This research was a descriptive–analytical study conducted on 100 patients. IAP was monitored every 4 h in patients suspected to be at high risk for ACS, e.g., those undergoing severe abdominal trauma and pelvic fracture. The IAP was measured via the urinary bladder.

Thank you for your attention