Increased Intra-Abdominal, Intrathoracic, and Intracranial Pressure After Severe Brain Injury: Multiple Compartment Syndrome

Abstract

Increased ICP may be from primary TBI or MCS. Patients with MCS have a higher Injury Severity Score, ICP, and fluid requirements, but no increase in mortality. Both DC and DL reduce ICP and can be used in sequence. MCS should be considered in multiply injured patients with increased ICP that does not respond to therapy.

The polycompartment syndrome: a concise state-of-the-art review

“…Remarkably, patients with polycompartment syndrome receive significantly more fluids during the first week of ICU stay and predictably their ICU/hospital admission is prolonged [4]. While there was also a trend towards higher mortality in these patients (42% vs 31%), statistical significance was not reached.…”

“…However, fluid therapy used to support CPP may exacerbate visceral oedema, promote ascites, and increase IAP, which in turn may increase intrathoracic (ITP), internal jugular venous, and intracranial pressures (possibly through decreased intracranial venous drainage via the jugular veins) [16]. Therefore, in patients with severe TBI, treatment decisions that may result in a vicious cycle, increasing pressures in various compartments, should be carefully considered [4].…”

“…Scalea et al first introduced the term 'multiple compartment syndrome' in a study of 102 patients with increased intra-abdominal (IAP), intrathoracic (ITP), and intracranial pressure (ICP) after severe traumatic brain injury [4]. They suggested that different compartments within the body are not isolated and independent entities, but instead should be considered closely interconnected.…”

Intra-abdominal Hypertension and Abdominal Compartment Syndrome

“…2,11,23 Either a transducer technique or a manometer technique can be used. The tools to measure IAP are readily available in any ICU, 19,21 and specialized kits can be purchased. The techniques and tools described here have been deemed acceptable by the WSACS.…”

“…18,19 The Munro-Kellie hypothesis states that the cranium is a nondistensible vault filled with brain tissue, cerebrospinal fluid, and blood. 20 If 1 of the vault's substances increases in size, the other 2 substances adjust their volume to compensate and maintain equilibrium.…”