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

3. 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.

4. 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

5. 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

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

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

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

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

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

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

12. Gastrointestinal: Mesenteric blood flow was reduced
Intestinal ischemia

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

14. 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.

15. 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.

17. SUPPORTIVE MANAGEMENT
Ventilatory support
Hemodynamic support

18. 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)

19. 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.

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

21. 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.

23. Thank you for your attention