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Abdominal compartment syndrome in children.
R Beck1, M Halberthal, Z Zonis
1Pediatric Intensive Care Unit (Drs. Beck, Halberthal, Zonis, and Bar-Joseph) and the Department of Pediatric Surgery (Drs. Shoshani and Hayari), Rambam Medical Center and the Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Summary
Abdominal compartment syndrome (ACS) is infrequent in critically ill children but requires prompt recognition. Timely abdominal decompression improves patient physiology, though overall mortality remains high.
Area of Science:
- Pediatric Critical Care Medicine
- Surgical Critical Care
- Pediatric Intensive Care
Background:
- Abdominal compartment syndrome (ACS) is a life-threatening condition characterized by increased intra-abdominal pressure (IAP).
- While extensively studied in adults, data on ACS in critically ill pediatric patients is less common.
- Understanding the unique aspects of ACS in children is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine the incidence, predisposing factors, clinical presentation, and outcomes of ACS in critically ill children.
- To compare the physiological changes and response to treatment in pediatric ACS patients with adult data.
- To identify key differences in primary diagnoses and underlying mechanisms of ACS in children versus adults.
Main Methods:
- A prospective study conducted over five years in a pediatric intensive care unit.
- Screening of all admitted patients for ACS, defined by IAP > 15 mm Hg and associated clinical signs.
- Uniform treatment protocol including decompressive laparotomy for diagnosed ACS.
Main Results:
- ACS occurred in 0.6% of 1762 pediatric ICU admissions, with 15 episodes in 10 patients.
- Primary diagnoses varied widely, including abdominal conditions, post-surgical states, and notably, central nervous system involvement.
- Decompressive laparotomy led to prompt physiological improvement, but the overall mortality rate was 60%.
Conclusions:
- Abdominal compartment syndrome is a rare but serious condition in critically ill children, with diverse etiologies.
- Early recognition and surgical decompression are vital for improving physiological parameters in pediatric ACS.
- Despite improvements post-intervention, mortality remains high, highlighting the severity of this syndrome in children.