Abdominal Compartment Syndrome Dr Saad ALQahtani Department of
Abdominal Compartment Syndrome Dr. Saad AL-Qahtani Department of Surgery College of medicine, King Saud University
Abdominal Compartment Syndrome • When IAP > 20 mm. Hg this is called “intra-abdominal hypertension” • But if IAP >25 -30 with at least one of the followings : compromised respiratory mechanisms & ventilation, oliguria or anuria or increase in ICP , this is “Abdominal Compartment Syndrome”
Abdominal Compartment Syndrome • Normal IAP < • Grade: I II IV 10 – 15 mm. Hg 16 – 25 mm. Hg 26 – 35 mm. Hg > 35 mm. Hg 10 mm. Hg
Abdominal Compartment Syndrome Eitiology Surgical 1 -Trauma 2 -post liver transplantation. 3 -tight surgical closures or burn scars. 4 -others ; ruptured AAA, pancreatic &intestinal injury will increase risk of development of IAH &ACS Non-surgical bowel obstruction , pancreatitis , massive ascites, peritonitis , ….
Abdominal Compartment Syndrome Progressive abd distetion Increased peak airway ventilator pressure Oliguria &anuria Intracranial hypertension
Abdominal Compartment Syndrome CNS Intra thoracic pressure + central venous pressure ICP • An elevated CVP &ICP with hypotension cerebral flow&ischemia. • CVS • • Reduction of CO , Venous return. Hypovolemia. Increase in PCWP , CVP. DVT.
Abdominal Compartment Syndrome Pulmonary • • • Increase in ITP, airway pressure, shunt fracion. Hypoxia , hypercarbia. Compression of chest lead to : atelectasis, edema , infection. Renal Reduction in UO, GFR, , …. . Renal failure
Abdominal Compartment Syndrome • ABDOMEN • CELIAC &SMA flow. • Compressionn of veins , venous HTN, intestinal edema , …. . Hypoperfusion , bowel ischemia & Lactic acidosis.
ACS : Bowel Edema Endothelial Permeability Capillary Hydrostatic Pressure Plasma Oncotic Pressure Transcapillary Fluid Flux Mesenteric Lymphatic Resistance Shock 2003
Abdominal Compartment Syndrome
Postinjury Damage Control : ACS MOF MORTALITY ACS + 32 % 43 % ACS - 8% 12 % Raeburn et al Am J Surg 2001
Abdominal Compartment Syndrome Management -Relase of abdominal fascia & keep it open. -Temporary abd closure techniques. ( vaccum assisted or vaccum pack) -If untreated , multiple system end-organ dysfunction or failure & high mortality.
Abdominal Compartment Syndrome
Abdominal Compartment Syndrome • I 10 – 15 mm. H maintain normovolemia • II 16 – 25 mm. Hg hypervolemic resuscitation • III 26 – 35 mm. Hg Decompression • IV > Decompression &reexploration 35 mm. Hg
Summary • Primary vs. Secondary Mechanisms • Sx : Pulmonary and Renal • Dx : Bladder Pressure Monitoring • Rx : Prompt Decompression • Prevention : ? ? ?
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