The role of routine measurement of intra-abdominal pressure in preventing abdominal compartment syndrome

Abstract

Introduction:Abdomen, a closed compartment, is prone to raised intra-abdominal pressure (IAP) in the postoperative period. After a critical value of ≥ 15 cm of water, IAP produces abdominal compartment syndrome (ACS). ACS leads to reduced venous return, reduced cardiac output, and domino effect of organ dysfunction, leading to death. Hence, it is the need of hour to monitor IAP to pick up intra-abdominal hypertension (IAH) and ACS. This routine facilitates early institution of treatment measures.Aims and Objectives:To study IAP in abdominal operations in neonates, infants, and older children and to promote concept of routine measurement of IAP as standard care.Materials and Methods:Intravesical route was used to measure IAP in this prospective observational study. Seventy-nine pediatric abdominal surgeries met with criteria of availability of complete data for analysis and formed the cohort of the study. All major, infective, traumatic, tumor-related abdominal surgeries were included in the study. Outcome, C-reactive protein (CRP), procalcitonin, platelet counts, Simplified Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were the parameters analyzed. The World Society of ACS grading was adopted in the study with subdivision of normal into low-normal and high-normal subgroups.Results:Extended Mantel–Haenszel Chi-square statistical tool when applied for linear relationship showed a linear relationship with outcome (P < 0.05), CRP (P < 0.05), procalcitonin (P < 0.05), Simplified Sequential organ failure Assessment Score, and APACHE II. Platelet counts (P > 0.05) were not significantly correlated. Decision for laparotomy was delayed in cases of ACS.Conclusion:Routine measure of IAP facilitates early recognition of IAH. This facilitates therapeutic measures to be initiated to reduce IAP. Early decision to decompress by laparotomy/laparostomy saves lives. Hence, routine IAP measurement should be a part of standard care in pediatric abdominal surgery.

Early Enteral Nutrition in Neonates Following Abdominal Surgery

“…Rise in IAP with post-operative feeding was evaluated in the present study by measuring intravesical pressures [18]. The fear of many that EEN adds to ileus was not supported by this study.…”

Hydrops fetalis and neonatal abdominal compartment syndrome continuum from immature gastric teratoma: a case report

“…The value of urgent decompression laparotomy for severe or recalcitrant ACS, which can also include the excision of the offending intraabdominal lesion as with the current case, cannot be overemphasized [22]. ACS, while long being a concern particularly for pediatric surgeons (specifically in managing abdominal wall defect cases), reportedly remains under-recognized and therefore under-treated in the pediatric population [23,24]. The collective experience with immature gastric teratoma epitomizes this situation.…”

Abdominal compartment syndrome caused by gastric distension in bulimia nervosa and fatal injury following surgical decompression - A case report -

“…According to Kirkpatrick et al [ 3 ], IAP grades can be divided into Grade I = IAP 12 to 15 mmHg, Grade II = IAP 16 to 20 mmHg, Grade III = IAP 21 to 25 mmHg, and Grade IV = IAP > 25 mmHg. According to the study performed by Prasad et al [ 4 ], a higher IAP grade significantly correlated with a higher mortality. In a Grade IV case, 71–85% mortality has been reported [ 5 ].…”