Postinjury Primary Abdominal Compartment Syndrome

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Surgical Complications

Background:

• Postinjury abdominal compartment syndrome (ACS) is a lethal complication linked to damage control surgery (DCS) in severely injured patients.
• DCS evolved in the 1980s to manage uncontrollable bleeding in trauma, but often involves packed abdomens and massive resuscitation, increasing ACS risk.
• While pathophysiological characteristics and risk factors for postinjury ACS are understood, mortality remains high.

Purpose of the Study:

• To review the evolution of postinjury ACS in the context of DCS.
• To highlight the importance of prevention strategies for postinjury ACS.
• To identify optimal preventive measures for reducing ACS-related morbidity and mortality.

Main Methods:

• Literature review of postinjury ACS and damage control surgery principles.
• Analysis of pathophysiological characteristics, risk factors, and diagnostic criteria for ACS.
• Evaluation of preventive strategies, including open abdomen management and hemostatic resuscitation.

Main Results:

• Damage control surgery has improved survival in severely injured patients but introduced ACS as a significant complication.
• Prevention, rather than solely earlier decompression, is the recommended strategy for managing postinjury ACS.
• Aggressive open abdomen management can minimize complications, but timely hemorrhage control and hemostatic resuscitation are crucial for effective prevention.

Conclusions:

• Postinjury ACS remains a critical challenge in trauma care, necessitating a shift towards proactive prevention.
• Effective prevention of postinjury ACS relies on timely hemorrhage control and hemostatic resuscitation.
• While open abdomen techniques are valuable, optimizing resuscitation and bleeding control offers the most promising avenue for reducing ACS incidence and improving patient outcomes.