Abdominal Compartment Syndrome (ACS) 

 

 

Background 

 

  • Definition: sustained intraabdominal pressure >20 mmHg that is associated with new organ dysfunction

  • Patients with an intraabdominal pressure <10 mmHg generally do not have ACS, while patients with an intraabdominal pressure >25 mmHg usually have ACS

  • Higher systemic blood pressure will be needed to perfuse abdominal organs, keep abdominal perfusion pressure (APP) (systemic blood pressure - intraabdominal pressure) >60mmHg

  • Etiology: 

    • Primary: due to injury or disease in the abdominopelvic region (e.g., pancreatitis, abdominal trauma)

      • Intervention (surgical or radiologic) of the primary condition is often needed 

    • Secondary: does not originate in the abdomen or pelvis (e.g., fluid resuscitation, sepsis, burns)

 

 

Considerations

 

  • Critically ill patient with high mortality & morbidity

  • Multisystemic dysfunction:

    • Airway: ↑ risk of aspiration

    • CVS: ↓ cardiac output (CO) from ↓ preload & ↑ SVR

    • Resp:  Hypoxia secondary to restrictive ventilation

    • Renal:  Potential for AKI 

    • GI:  Hepatic dysfunction (altered pharmokinetics)

  • Need to maintain APP > 60 mmHg

  • Consequences of decompression:

    • Sudden ↓ in cardiac output & SVR

    • Reperfusion: risk of systemic acidosis & hyperkalemia

    • Possible fatal arrhythmia & arrest

    • Sudden change in respiratory compliance (avoid overventilation)

 

 

Goals/Conflicts

 

  • Early identification of ACS

  • Maintain APP >60mmHg

  • Avoid bradycardia (preload is compromised & CO may be heart rate dependent)

  • Maintain high preload particularly once decompressed

  • Be prepared for sudden arrhythmias associated with hyperkalemia & acidosis after decompression occurs