ABDOMINAL COMPARTMENT SYNDROME AMONG CRITICALLY ILL SURGICAL AND TRAUMATISED PATIENTS: EXPERIENCE AT PIMS, ISLAMABAD

Muhammad Saaiq, Syed Aslam Shah, Tanwir Khaliq

Abstract


Background: Raised intra-abdominal pressure (IAP) accompanied by evidence of organ dysfunction
constitutes abdominal compartment syndrome (ACS). The ACS is now becoming an increasingly
recognised fatal entity in the critically ill surgical and traumatized patients receiving critical care. The
objectives were to determine the frequency of abdominal compartment syndrome (ACS) in critically ill
surgical and traumatised patients and to identify the risk factors associated with its development in our
patients. Methods: This descriptive study was conducted at Department of Surgery, Pakistan Institute
of Medical Sciences (PIMS), Islamabad from July 2004 to February 2005. Two hundred critically ill
adult surgical and traumatised patients who needed catheterisation were included in the study. Patients
who had cardiac tamponade, tension pneumothorax, status asthmaticus, bladder outflow obstruction,
pre-existing end organ failure and those not consenting to participate in the study were excluded.
Diagnosis of the underlying surgical condition was made by history, physical examination and
necessary investigations. The main diagnostic tool employed for detecting ACS was the measurement
of intra-cystic pressure (ICP) which was taken as an indirect measure of intra-abdominal pressure
(IAP). It was measured four hourly by employing simple fluid column manometry method. Blood
pressure, pulse rate, temperature, respiratory rate and urine output were recorded 4 hourly. Arterial
blood gases (ABGs) and renal function tests (RFTs) were performed daily. ACS was diagnosed on the
basis of raised IAP of >10 mmHg coupled with evidence of one or more end organ failure. A variety
of risk factors that lead to ACS were studied among the patients. Results: Out of 200 patients, six had
ACS. The overall frequency was thus 3%. The M:F was 2:1. Most of the patients were in the age range
of 31–40 years. Severe peritonitis, severe gut oedema, SIRS and tense ascites were recognised as
statistically significant risk factors for the development of ACS. All patients with ACS had features of
multiorgan dysfunction. There was 80% in-hospital mortality among the ACS sufferers. Conclusion:
ACS develops in a significant number of critically ill and traumatised patients developing quickly and
proving fatal without ACS specific interventions. All such high risk patients should undergo serial ICP
measurements as a screening test for early detection of ACS.
Keywords: Abdominal compartment syndrome, ACS, Intra-abdominal pressure, Intra-cystic pressure

References


Rotondo MF, Cheatham ML, Moore F, Reilly P. Symposium.

Abdominal compartment syndrome. Contemp Surg

;59:260–70.

Burch JM, Moore EE, Moore FA, Franciose R . The

abdominal compartment syndrome. Surg Clin North Am

;76:833–42.

Nathens AB, Brenneman FD, Boulanger BR. The abdominal

compartment syndrome. Can J Surg 1997;40:254–62.

Coombs HC. The mechanism of the regulation of intraabdominal pressure. Am J Physiol 1920;61:159–63.

Schein M, Wittmann DH, Aprahamian CC, Condon RE. The

abdominal compartment syndrome: the physiological and

clinical consequences of elevated intra-abdominal pressure. J

Am Coll Surg 1995;180:745–53.

Ivatuary RR, Diebel L, Porter JM, Simon RJ. Intraabdominal hypertension and the abdominal compartment

syndrome. Surg Clin North Am 1997; 77:783–800.

Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased

intra-abdominal pressure on mesenteric arterial and intestinal

mucosal blood flow. J Trauma 1992;33:45–9.

Ivatuary RR, Porter JM, Simon RJ, Islam S , Ranjit J , Stahl

WM. Intra-abdominal hypertension after life threatening

penetrating abdominal trauma; prophylaxis, incidence,

clinical relevance to gastric mucosal pH and abdominal

compartment syndrome..J Trauma Injury Infect Crit Care

;44:1016–23.

Fietsam R Jr, Villalba M, Glover JL. Intra-abdominal

compartment syndrome as a complication of ruptured

abdominal aortic aneurysm repair. Am Surg 1989;55:396–402.

Cerabona T, Savino J, Agarwal N. Urinary bladder

measurements of intra-abdominal pressure (IAP) in ascitic

cirrhotics predictive of hemodynamic and renal function. Crit

Care Med 1988;16:431.

Meldrum DR, Moore FA, Moore EE. Cardiopulmonary

hazards of perihepatic packing for major liver injuries. Am J

Surg 1995;170:537–40.

Kron IL, Harman PK, Nolan SP. The measurement of intraabdominal pressure as a criterion for abdominal reexploration. Ann Surg 1984;199:28–30.

Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia

A, Burch JM. Prospective characterization and selective

management of the abdominal compartment syndrome. Am J

Surg 1997;174:667–73.

J Ayub Med Coll Abbottabad 2009;21(2)

http://www.ayubmed.edu.pk/JAMC/PAST/21-2/Saaiq.pdf 155

Eddy V, Nunn C, Morris JA. Abdominal compartment

syndrome. Surg Clin North Am 1997;77:801–11.

Eddy Va, Key SP, Morris JA Jr. Abdominal compartment

syndrome: etiology, detection and management. J Tenn Med

Assoc 1994;87:55–7.

Yol S, Kartal A, Tavli S, Tatkan Y. Is urinary bladder

pressure a sensitive indicator of intra-abdominal pressure?

Endoscopy 1998;30:778-80.

Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A

simple technique to accurately determine intra-abdominal

pressure. Crit Care Med 1987;15:1140–2.

Sedrak M, Major K, Wilson M. Simple fluid-column

manometry to monitor for the development of abdominal

compartment syndrome. Contemp Surg 2002;58:228.

Smith PC, Tweddell JS, Bessey PQ. Alternative approaches

to abdominal wound closure in severely injured patients with

massive visceral edema. J Trauma 1992;32:16–20.

Mayberry JC, Mullins RJ, Crass RA, Trunkey DD.

Prevention of abdominal compartment syndrome by

absorbable mesh prosthesis closure. Arch Surg

;132:957–61.

Fernandez L, Norwood S, Roettger R. Temporary

intravenous bag silo closure in severe abdominal trauma. J

Trauma 1996;40:258–60.

Joynt GM, Ramsay SJ, Buckley TA. Intra-abdominal

hypertension-implications for the intensive care physician.

Ann Acad Med Singapore 2001;30:301–9.

Gecelter G, Fahoum B, Gardezi S, Schein M. Abdominal

compartment syndrome in severe acute pancreatitis: an

indication for a decompressing laparotomy. Dig Surg

;19:402–5.

Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, Mc

Kenny MG. Prospective study of the incidence and outcome

of intra-abdomnal hypertension and the abdominal

compartment syndrome. Br J Surg 2002;89:591–6.

Malbrain ML. Different techniques to measure intraabdominal pressure: time for a critical re-appraisal. Intensive

Care Med 2004;30:357–71.

Fusco MA, Martin RS, Chang MC. Estimation of intraabdominal pressure by bladder pressure measurement:

validity and methodology. J Trauma 2001;50:297–302.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]