ABDOMINAL COMPARTMENT SYNDROME AMONG CRITICALLY ILL SURGICAL AND TRAUMATISED PATIENTS: EXPERIENCE AT PIMS, ISLAMABAD
AbstractBackground: Raised intra-abdominal pressure (IAP) accompanied by evidence of organ dysfunctionconstitutes abdominal compartment syndrome (ACS). The ACS is now becoming an increasinglyrecognised fatal entity in the critically ill surgical and traumatized patients receiving critical care. Theobjectives were to determine the frequency of abdominal compartment syndrome (ACS) in critically illsurgical and traumatised patients and to identify the risk factors associated with its development in ourpatients. Methods: This descriptive study was conducted at Department of Surgery, Pakistan Instituteof Medical Sciences (PIMS), Islamabad from July 2004 to February 2005. Two hundred critically illadult surgical and traumatised patients who needed catheterisation were included in the study. Patientswho had cardiac tamponade, tension pneumothorax, status asthmaticus, bladder outflow obstruction,pre-existing end organ failure and those not consenting to participate in the study were excluded.Diagnosis of the underlying surgical condition was made by history, physical examination andnecessary investigations. The main diagnostic tool employed for detecting ACS was the measurementof intra-cystic pressure (ICP) which was taken as an indirect measure of intra-abdominal pressure(IAP). It was measured four hourly by employing simple fluid column manometry method. Bloodpressure, pulse rate, temperature, respiratory rate and urine output were recorded 4 hourly. Arterialblood gases (ABGs) and renal function tests (RFTs) were performed daily. ACS was diagnosed on thebasis of raised IAP of >10 mmHg coupled with evidence of one or more end organ failure. A varietyof risk factors that lead to ACS were studied among the patients. Results: Out of 200 patients, six hadACS. The overall frequency was thus 3%. The M:F was 2:1. Most of the patients were in the age rangeof 31–40 years. Severe peritonitis, severe gut oedema, SIRS and tense ascites were recognised asstatistically significant risk factors for the development of ACS. All patients with ACS had features ofmultiorgan dysfunction. There was 80% in-hospital mortality among the ACS sufferers. Conclusion:ACS develops in a significant number of critically ill and traumatised patients developing quickly andproving fatal without ACS specific interventions. All such high risk patients should undergo serial ICPmeasurements as a screening test for early detection of ACS.Keywords: Abdominal compartment syndrome, ACS, Intra-abdominal pressure, Intra-cystic pressure
Rotondo MF, Cheatham ML, Moore F, Reilly P. Symposium.
Abdominal compartment syndrome. Contemp Surg
Burch JM, Moore EE, Moore FA, Franciose R . The
abdominal compartment syndrome. Surg Clin North Am
Nathens AB, Brenneman FD, Boulanger BR. The abdominal
compartment syndrome. Can J Surg 1997;40:254–62.
Coombs HC. The mechanism of the regulation of intraabdominal pressure. Am J Physiol 1920;61:159–63.
Schein M, Wittmann DH, Aprahamian CC, Condon RE. The
abdominal compartment syndrome: the physiological and
clinical consequences of elevated intra-abdominal pressure. J
Am Coll Surg 1995;180:745–53.
Ivatuary RR, Diebel L, Porter JM, Simon RJ. Intraabdominal hypertension and the abdominal compartment
syndrome. Surg Clin North Am 1997; 77:783–800.
Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased
intra-abdominal pressure on mesenteric arterial and intestinal
mucosal blood flow. J Trauma 1992;33:45–9.
Ivatuary RR, Porter JM, Simon RJ, Islam S , Ranjit J , Stahl
WM. Intra-abdominal hypertension after life threatening
penetrating abdominal trauma; prophylaxis, incidence,
clinical relevance to gastric mucosal pH and abdominal
compartment syndrome..J Trauma Injury Infect Crit Care
Fietsam R Jr, Villalba M, Glover JL. Intra-abdominal
compartment syndrome as a complication of ruptured
abdominal aortic aneurysm repair. Am Surg 1989;55:396–402.
Cerabona T, Savino J, Agarwal N. Urinary bladder
measurements of intra-abdominal pressure (IAP) in ascitic
cirrhotics predictive of hemodynamic and renal function. Crit
Care Med 1988;16:431.
Meldrum DR, Moore FA, Moore EE. Cardiopulmonary
hazards of perihepatic packing for major liver injuries. Am J
Kron IL, Harman PK, Nolan SP. The measurement of intraabdominal pressure as a criterion for abdominal reexploration. Ann Surg 1984;199:28–30.
Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia
A, Burch JM. Prospective characterization and selective
management of the abdominal compartment syndrome. Am J
J Ayub Med Coll Abbottabad 2009;21(2)
Eddy V, Nunn C, Morris JA. Abdominal compartment
syndrome. Surg Clin North Am 1997;77:801–11.
Eddy Va, Key SP, Morris JA Jr. Abdominal compartment
syndrome: etiology, detection and management. J Tenn Med
Yol S, Kartal A, Tavli S, Tatkan Y. Is urinary bladder
pressure a sensitive indicator of intra-abdominal pressure?
Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A
simple technique to accurately determine intra-abdominal
pressure. Crit Care Med 1987;15:1140–2.
Sedrak M, Major K, Wilson M. Simple fluid-column
manometry to monitor for the development of abdominal
compartment syndrome. Contemp Surg 2002;58:228.
Smith PC, Tweddell JS, Bessey PQ. Alternative approaches
to abdominal wound closure in severely injured patients with
massive visceral edema. J Trauma 1992;32:16–20.
Mayberry JC, Mullins RJ, Crass RA, Trunkey DD.
Prevention of abdominal compartment syndrome by
absorbable mesh prosthesis closure. Arch Surg
Fernandez L, Norwood S, Roettger R. Temporary
intravenous bag silo closure in severe abdominal trauma. J
Joynt GM, Ramsay SJ, Buckley TA. Intra-abdominal
hypertension-implications for the intensive care physician.
Ann Acad Med Singapore 2001;30:301–9.
Gecelter G, Fahoum B, Gardezi S, Schein M. Abdominal
compartment syndrome in severe acute pancreatitis: an
indication for a decompressing laparotomy. Dig Surg
Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, Mc
Kenny MG. Prospective study of the incidence and outcome
of intra-abdomnal hypertension and the abdominal
compartment syndrome. Br J Surg 2002;89:591–6.
Malbrain ML. Different techniques to measure intraabdominal pressure: time for a critical re-appraisal. Intensive
Care Med 2004;30:357–71.
Fusco MA, Martin RS, Chang MC. Estimation of intraabdominal pressure by bladder pressure measurement:
validity and methodology. J Trauma 2001;50:297–302.