Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review

Abstract

Abdominal Compartment Syndrome (ACS), despite recent advances in medical and surgical care, is a significant cause of mortality. The purpose of this review is to present the main diagnostic and therapeutic aspects from the anesthetical and surgical points of view. Intra-abdominal hypertension may be diagnosed by measuring intra-abdominal pressure and indirectly by imaging and radiological means. Early detection of ACS is a key element in the ACS therapy. Without treatment, more than 90% of cases lead to death and according with the last reports, despite all treatment measures, the mortality rate is reported as being between 25 and 75%. There are conflicting reports as to the importance of a conservative therapy approach, although such an approach is the central to treatment guidelines of the World Society of Abdominal Compartment Syndrome, Decompressive laparotomy, although a backup solution in ACS therapy, reduces mortality by 16-37%. The open abdomen management has several variants, but negative pressure wound therapy represents the gold standard of surgical treatment.

An Ingestible Electronics for Continuous and Real-Time Intraabdominal Pressure Monitoring

“…The abdominal compartment normally sustains a pressure of approximately 5–7 mm Hg [ 28 ], and many pathologic conditions can generate sustained pressures greater than 12 mm Hg [ 7 ], a state referred to as IAH, producing subclinical organ dysfunctions leading to multiple organ dysfunction syndromes [ 5 ]. Thus, ACS is seen as the result of a sustained IAH [ 29 ] Increased attention to IAP, along with changes in the clinical management of critically ill or injured patients, has led to exponential growth in research relating to IAH and ACS in recent years.…”

“…Trigger factors located inside the abdominal cavity can induce primary ACS, whereas those outside of the abdominopelvic cavity can contribute to the development of secondary ACS. Currently, IVP monitoring is considered the acceptable measurement route [ 5 , 7 , 31 ]. Although the benefits of IVP monitoring in the diagnosis, prevention, and management of IAH have been demonstrated, some clinicians remain reluctant to institute this monitoring technique out of concern for increasing the patient’s risk of device-related nosocomial urinary tract infection while potentially altering the aseptic condition of the urinary drainage system [ 32 ].…”

“…Monitoring intraabdominal pressure (IAP) is mandatory, particularly in critically ill patients in intensive care units [ 4 ]. Moreover, given the risk factors that could lead to an increase in IAP and progression to ACS, IAP monitoring has made it possible to detect early signs of IAH in patients under treatment [ 5 ]. The early detection of ACS is key to obtaining the best treatment results [ 6 ].…”

Continuous Intra-Gastral Monitoring of Intra-Abdominal Pressure in Critically ill Children – A Validation Study

“…Experienced clinicians rely on their clinical "semi-quantative" estimation of IAP through palpation. Unfortunately, this practice has been shown to only poorly correlate with quantitative IAP measurement [5,6] and cannot replace it [7,8].…”

A Case of Lethal Abdominal Compartment Syndrome due to Rapidly Expanding Ovarian Small Cell Carcinoma Pulmonary Type

“…While most cases of primary IAH result from peritonitis, pancreatitis, and inflammatory or oncologic diseases, other causes include aortic aneurysm, abdominal and retroperitoneal tumors, mechanical bowel obstruction, abdominal trauma, and ascites [3]. Secondary causes include obesity, large volume fluid resuscitation, and sepsis [4]. ACS has many systemic effects, including decreased renal and hepatic portal blood flow, resulting in decreased cardiac output and decreased lung and chest wall compliance [2].…”