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

Abstract

Background: Raised intra-abdominal pressure (IAP) accompanied by evidence of organ dysfunctionconstitutes abdominal compartment syndrome (ACS). The ACS is now becoming an increasinglyrecognised fatal entity in the critically ill surgical and traumatized patients receiving critical care. Theobjectives were to determine the frequency of abdominal compartment syndrome (ACS) in critically illsurgical and traumatised patients and to identify the risk factors associated with its development in ourpatients. Methods: This descriptive study was conducted at Department of Surgery, Pakistan Instituteof Medical Sciences (PIMS), Islamabad from July 2004 to February 2005. Two hundred critically illadult surgical and traumatised patients who needed catheterisation were included in the study. Patientswho 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 andnecessary investigations. The main diagnostic tool employed for detecting ACS was the measurementof 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. Bloodpressure, pulse rate, temperature, respiratory rate and urine output were recorded 4 hourly. Arterialblood gases (ABGs) and renal function tests (RFTs) were performed daily. ACS was diagnosed on thebasis of raised IAP of >10 mmHg coupled with evidence of one or more end organ failure. A varietyof risk factors that lead to ACS were studied among the patients. Results: Out of 200 patients, six hadACS. The overall frequency was thus 3%. The M:F was 2:1. Most of the patients were in the age rangeof 31–40 years. Severe peritonitis, severe gut oedema, SIRS and tense ascites were recognised asstatistically significant risk factors for the development of ACS. All patients with ACS had features ofmultiorgan 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 andproving fatal without ACS specific interventions. All such high risk patients should undergo serial ICPmeasurements as a screening test for early detection of ACS.Keywords: Abdominal compartment syndrome, ACS, Intra-abdominal pressure, Intra-cystic pressure