Intra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma

Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction among patients with trauma and sepsis. However, the impact of increased intra-abdominal pressure (IAP) among pediatric, pregnant, non-septic medical patients, and those with severe acute pancreatitis (SAP), obesity, and burns has been studied less extensively. The aim of this review is to outline the pathophysiologic implications and treatment options for IAH and abdominal compartment syndrome (ACS) for the above patient populations. We searched MEDLINE and PubMed to identify relevant studies. There is an increasing awareness of IAH in general medicine. The incidence of IAH and, to a lesser extent, ACS is high among patients with SAP. IAH should always be suspected and IAP measured routinely. In children, normal IAP in mechanically ventilated patients is approximately 7 ± 3 mm Hg. As an IAP of 10-15 mm Hg has been associated with organ damage in children, an IAP greater than 10 mm Hg should be considered IAH in these patients. Moreover, as ACS may occur in children at an IAP lower than 20 mm Hg, any elevation in IAP higher than 10 mm Hg associated with new organ dysfunction should be considered ACS in children until proven otherwise. Monitor IAP trends and be aware that specific interventions may need to be instituted at lower IAP than the current ACS definitions accommodate. Finally, IAH and ACS can occur both in abdominal trauma and extra-abdominal trauma patients. Early mechanical hemorrhage control and the avoidance of excessive fluid resuscitation are key elements in preventing IAH in trauma patients. IAH and ACS have been associated with many conditions beyond the general ICU patient. In adults and in children, the focus should be on the early recognition of IAH and the prevention of ACS. Patients at risk for IAH should be identified early during their treatment (with a low threshold to initiate IAP monitoring). Appropriate actions should be taken when IAP increases above 20 mm Hg, especially in patients developing difficulty with ventilation. Although on-operative measures should be instituted first, one should not hesitate to resort to surgical decompression if they fail.