Abdominal compartment syndrome in children

Abstract

OBJECTIVE: To investigate the frequency, predisposing factors, clinical presentation, and outcome of abdominal compartment syndrome (ACS) in critically ill pediatric patients. DESIGN: A prospective study over a 5-yr period. SETTING: Pediatric intensive care unit of a tertiary care, university hospital. PATIENTS: All patients admitted to the pediatric intensive care unit were screened for the presence of ACS and were treated with a uniform protocol. ACS was defined as abdominal distention with intra-abdominal pressure (IAP) > 15 mm Hg, accompanied by at least two of the following: oliguria or anuria; respiratory decompensation; hypotension or shock; metabolic acidosis. MEASUREMENTS AND MAIN RESULTS: Of 1762 patients admitted over 5 yrs, ten patients (0.6%) had a total of 15 episodes of ACS. Of 406 trauma cases, three had ACS (0.7%). Three of the ten patients had primary abdominal conditions (mesenteric vein thrombosis, intussusception, enterocolitis), three had abdominal surgery (trauma, Kasai operation, esophageal perforation and peritonitis), three had primary central nervous system involvement, and one had meningococcemia. At laparotomy, bowel ischemia or necrosis was found in four episodes of ACS (27%). Mean IAP at diagnosis of ACS was 23.9 +/- 3.8 (range 17-31) mm Hg. Physiologic parameters were compared during 4 hrs before the development of ACS, during ACS, and after abdominal decompression. Mean arterial pressure, Pao(2), Pao(2)/Fio(2) ratio, and urinary output decreased significantly, whereas Paco(2), peak inspiratory pressures, positive end-expiratory pressures, and base deficit increased significantly after the development of ACS. After decompressive laparotomy, the condition of the patients improved promptly and these variables returned to pre-ACS values. Overall mortality rate in this group was 60%. CONCLUSIONS: Although relatively infrequent compared with adults, ACS occurs in critically ill children. Timely decompression of the abdomen results in uniform improvement, but overall mortality is still high. In contrast with adults, children with ACS have diverse primary diagnoses, with a significant number of primary extra-abdominal-mainly central nervous system-conditions. Ischemia and reperfusion injury appear to be the major mechanisms for development of ACS in children. Clinical presentation is similar to adults, but children may develop ACS at a lower IAP (as low as 16 mm Hg).

Abdominal Compartment Syndrome in Children

“…7,8,48,49 Thus, ACS is a clinically important problem in critically ill patients that can be ameliorated by early recognition of IAH and appropriate medical or surgical intervention for IAH and impending ACS. Bedside critical care nurses are responsible for accurately measuring IAP and alerting physicians about important observed changes.…”

“…As a result, lower IAP cutoff values of 12 and 15 mm Hg have been used to define ACS in children. 7,8 For an individual child, the actual IAP value may be less important than the impact of the pressure on organ function. Normal IAP is 7 (SD, 3) mm Hg in children, 5 so ACS in a child may be more appropriately Jennifer Newcombe, MSN, CNS, CPNP Mudit Mathur, MD J. Chiaka Ejike, MD …”

“…7,[9][10][11][12] The reported incidence of ACS varies from less than 1% to 60%, depending on the definitions used and the different populations of patients studied. 7,8,[12][13][14] Many health care providers think ACS may be underrecognized and thus underreported.…”

“…Indirect measurements include those determined by using intragastric, intrarectal, vena caval, intrauterine, and intra vesical methods. 8,28,29 The gold standard for IAP measurement is the direct method, but this method is invasive and can be associated with complications such as bowel perforation and peritonitis. 30 The most accepted standard for indirectly measuring IAP is the bladder method.…”

Can high risk diseases for increasing intraabdominal pressure be treated more efficiently under intravesical pressure measurement?

“…Sonuçta gelişen çoklu organ yetersizliği tablosu, çocuklarda yüksek oranda mortaliteye yol açabilen abdominal kompartman sendromu (AKS) olarak adlandırılmaktadır (%50-60). [1][2][3] İntravezikal basınç (İVB) ölçümü, İAB'nin saptanmasında klinik kullanımı kolay ve güvenilir bir yöntem olması nedeniyle öncelikle tercih edilmektedir.[4] Çocuklarda çeşitli klinik durumların izlem ve tedavileri sırasında İAB artışı gelişebilmek-tedir. Abdominal travma, karın ön duvarı defektleri, adheziv bağırsak tıkanıklığı ve septik şokta sıvı resüsitasyonu çocukluk çağında karıniçi basınç artışına neden olabilen yüksek riskli hastalıklardan bazılarıdır.…”