Abdominal compartment syndrome: Difference between revisions
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**[[Increased ICP]] | **[[Increased ICP]] | ||
**Decreased cardiac preload | **Decreased cardiac preload | ||
**Increased cardiac afterload | |||
*Increased intrathoracic pressure | *Increased intrathoracic pressure | ||
**Decreased lung compliance | **Decreased lung compliance (will cause high peak pressures in vented patients) | ||
**Decreased functional residual capacity | **Decreased functional residual capacity | ||
**Worsened [[hypoxia|V/Q mismatch]] | **Worsened [[hypoxia|V/Q mismatch]] |
Revision as of 14:16, 6 May 2020
Background
- Organ dysfunction caused by intrabdominal hypertension
- Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics
Pathophysiology
- Abdominal perfusion pressure = MAP - intrabdominal pressure
- Build up of fluid or blood within the peritoneum or retroperitoneum
- And/or decrease in abdominal wall compliance
- Increased pressure within cavity of fixed volume → hypoperfusion of abdominal organs
- Also causes restriction of diaphragmatic excursion and impaired central venous return
Causes
- Acute Pancreatitis
- Ascites
- Diffuse peritonitis
- Large volume fluid resuscitation
- Reperfusion of ischemic bowel
- Retroperitoneal hemorrhage
- Small bowel obstruction
- Trauma
Clinical Features
- Most patients are critically ill and unable to communicate
- Decreased central venous return
- Increased JVP
- Increased ICP
- Decreased cardiac preload
- Increased cardiac afterload
- Increased intrathoracic pressure
- Decreased lung compliance (will cause high peak pressures in vented patients)
- Decreased functional residual capacity
- Worsened V/Q mismatch
- Oliguria, renal failure
- Bowel ischemia
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
Physical exam is neither sensitive nor specific
- Obtain bladder pressure
- Measurement >20mmHg WITH new organ dysfunction is indicative of compartment syndrome
Management
Nonoperative
Often first line approach when no abdominal injury present[1]
- Limit fluid resuscitation
- Nasogastric and bladder decompression
- Electrolyte repletion
- Antibiotics
- Pressors
- CRRT
- Percutaneous fluid drainage
Operative
Definitive treatment
- Laparotomy provides decompression
- High complication rate
- No guidelines for timing of closure
Disposition
- Admit
See Also
- "Traditional" compartment syndrome
References
- ↑ Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).