Abdominal compartment syndrome: an under-diagnosed contributory factor to morbidity and mortality in the critically

J D Hunter1

  • 1Department of Anaesthetics and Intensive Care, Macclesfield District General Hospital, Victoria Road, Macclesfield SK10 3BL, UK. jdhunter@talk21.com

Insights

Elevated intra-abdominal pressure (IAP) above 12 mm Hg can cause organ dysfunction. Persistently high IAP, especially over 20 mm Hg, leads to abdominal compartment syndrome, a critical condition with high mortality.

Area of Science:

  • Critical Care Medicine
  • Surgical Physiology
  • Abdominal Medicine

Background:

  • The abdomen functions as a closed cavity, meaning increased contents directly elevate intra-abdominal pressure (IAP).
  • Normal IAP is below 7 mm Hg.
  • Sustained IAP exceeding 12 mm Hg is linked to significant organ system dysfunction.

Purpose of the Study:

  • To highlight the physiological consequences of elevated intra-abdominal pressure.
  • To define abdominal compartment syndrome (ACS).
  • To emphasize the critical importance of recognizing and managing increased IAP and ACS.

Main Methods:

  • Review of physiological principles governing intra-abdominal pressure.
  • Discussion of clinical conditions associated with elevated IAP in intensive care settings.
  • Definition and clinical implications of abdominal compartment syndrome.

Main Results:

  • Intra-abdominal pressure persistently above 12 mm Hg compromises renal, intestinal, pulmonary, cardiovascular, and central nervous system function.
  • Intra-abdominal pressure continually above 20 mm Hg can precipitate organ system failure, defining abdominal compartment syndrome.
  • Failure to diagnose and manage ACS results in substantial morbidity and mortality.

Conclusions:

  • Increased intra-abdominal pressure is a significant physiological challenge in critical care.
  • Abdominal compartment syndrome is a life-threatening condition requiring prompt recognition and intervention.
  • Effective management of elevated IAP is crucial for improving patient outcomes in intensive care units.

Related Concept Videos

Intestinal Obstruction II: Pathophysiology01:07

Intestinal Obstruction II: Pathophysiology

Intestinal obstruction triggers a series of physiological responses, starting with gas and fluid accumulation in the bowel segment proximal to the obstruction, leading to distension. This distended intestine compresses the diaphragm, hindering lung expansion and potentially leading to reduced respiratory effort, atelectasis, and pneumonia.To overcome the blockage, the gut intensifies contractions, causing colicky abdominal pain, nausea, and vomiting, which reduces fluid and food intake and...
Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

Aneurysm II: Clinical Manifestations and Diagnostic Studies

Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Acute Pancreatitis II: Pathophysiology01:21

Acute Pancreatitis II: Pathophysiology

The pathophysiology of acute pancreatitis centers on injury to pancreatic acinar cells, which initiates a cascade of harmful intracellular events.This injury leads to premature activation of trypsinogen to trypsin in the pancreas. Trypsin then activates other digestive enzymes, such as chymotrypsin, elastase, and phospholipase A2, which begin breaking down pancreatic tissue. The resulting autodigestion causes local inflammation, tissue swelling, hemorrhage, and fat necrosis.Injured acinar cells...
Ascites01:19

Ascites

DefinitionAscites is the buildup of fluid inside the peritoneal cavity. It occurs when fluid moves out of the vascular system faster than the peritoneal lymphatics can remove it. This fluid shift is most commonly seen in liver cirrhosis but can also appear in several other systemic disorders.EtiologyCirrhosis remains the leading cause of ascites. Other conditions that can contribute include:Heart failureConstrictive pericarditisAbdominal cancersNephrotic syndromeSevere protein–calorie...
Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
Appendicitis01:19

Appendicitis

Appendicitis is an acute inflammatory condition of the vermiform appendix, most commonly caused by obstruction of its lumen. The appendix is a narrow, blind-ended pouch that extends from the cecum, making it particularly prone to obstruction. Causes include fecaliths, lymphoid hyperplasia (often after viral infections), parasites, tumors, or foreign bodies. This obstruction initiates a cascade of pathological changes.Luminal Obstruction and Early InflammationAfter obstruction, normal mucosal...