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Background
First
described
in
postop
AAA
patients,
back
in
1980s
Underecognised
in
the
past,
more
awareness
now
www.WSACS.org
ACS
Alters
organ
perfusion
and
end
organ
function
Associated
with
increased
morbidity
and
mortality
Definitions
High
BMI,
Pregnancy
Mechanical
Ventilation
Abdominal
Surgery
Abdominal
wall
eschar
Major
trauma
Prone
positioning
Burns
Pnemoperitonem
Gastroparesis
Gastric
Distension,
Ileus
Colonic
pseudoobstruction
Hemo/pneumoperitoneum
Intra-abdominal
infection/abscess
Intra-abdominal
tumors
Laparoscopy
with
excessive
insufflation
pressures
Cirrhosis
with
ascites
Peritoneal
dialysis
Acute
Pancreatitis
Systemic
Effects
Cerebral
Cardiac
Respiration
Renal
GI
Increase
in
abdominal
pressure
decreases
renal
blood
flow/
GFR
AKI.
The
rennin
angiotensin
system
is
activated
further
adding
to
intra-
abdominal
pressure
and
cardiac
workload.
Increased
intra-
abdominal
pressure
results
in
an
increase
in
vascular
resistance
and
decreased
cardiac
output.
Results
in
a
decrease
in
tissue
perfusion/ischemia.
Mucosal
sloughing,
Bacterial
translocation,
Sepsis.
Peripheral
Perfusion
Diagnosis
Treatment
Key
Points:
Intra-abdominal
hypertension
(IAH)
and
abdominal
compartment
syndrome
(ACS)
occur
frequently
in
critical
care
and
can
alter
organ
perfusion
and
end
organ
function.
Measurement
of
Intra-abdominal
pressure
(IAP)
is
done
via
the
bladder.
ACS
is
classified
as
an
IAP
greater
than
20
mmHg
with
a
new
organ
dysfunction.
Think
of
ACS
in
patients
with
worsening
renal
function,
high
peak/plateau
pressures,
worsening
ICP,
decreased
UO
consider
ACS
and
check
bladder
pressure.
For
Further
Reading:
1.
2.
3.
4.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680657/pdf/134_2013_Article_2906.
pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925290/pdf/1752-2897-8-2.pdf
http://www.aacn.org/wd/cetests/media/c1212.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132369/
Thanks!
Questions/Comments/Feedback
Lakshay
Chanana
drlakshay_em@yahoo.com
EMDidactic
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Academy
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