Abdominal Compartment Syndrome

Excerpt

Compartment syndrome can occur in any anatomical area with increased pressure in a confined body space, resulting in poor blood flow, cellular damage, and eventual organ dysfunction. These compartments are restricted by muscles and fascia, limiting the compartment's ability to expand as pressure progressively increases. Abdominal compartment syndrome (ACS) is especially well-studied due to its prevalence in critically ill patients and the potential for multisystem organ failure.

The World Society of Abdominal Compartment Syndrome (WSACS) was created in 2004. This society standardized the definitions and guidelines for evaluating and treating ACS, as this disease process is often underdiagnosed in the medical field. The intra-abdominal pressure (IAP) is the steady-state pressure within the abdomen. The average normal adult IAP ranges from 0 to 5 mm Hg, while IAP can be elevated up to 5 to 7 mm Hg in critically ill patients. Both patient body habitus and chronic medical conditions can influence the patient's baseline IAP; thus, they must be considered during ACS evaluation. Elevated IAP can lead to intra-abdominal hypertension (IAH), defined as IAP ≥ 12 mm Hg, but is not synonymous with ACS. ACS can occur when IAP is >20 mm Hg. However, the beginning phases of organ dysfunction can occur before IAP reaches 20 mm Hg.

Failure to recognize and immediately manage ACS can lead to poor prognosis and is recognized as an independent predictor of mortality. High clinical suspicion with protocolized monitoring and management should be implemented when treating critically ill patients, especially those with significant fluid shifts. This diagnosis should always be considered in patients with tense and distended abdomens and associated clinical instability. The abdomen is one of many anatomically confined spaces within the body. All compartments within the body are connected to multiple organ systems through physiologic systems; thus, increased IAP will also affect the surrounding areas and can lead to multiple organ dysfunction. With prompt identification of the causes of ACS and early interventions, organ dysfunction can be reversible.