Dr. A.H.

Kuncoro

ABDOMINAL COMPARTMENT SYNDROME

ADULT
DEFINITIONS
WCACS, ANTWERP BELGIUM 2007

Intra-abdominal Pressure (IAP): Intrinsic

pressure within the abdominal cavity
Intra-abdominal Hypertension (IAH): An IAP >
12 mm Hg (often causing occult ischemia)
without obvious organ failure
Abdominal Compartment Syndrome (ACS): IAH
with at least one overt organ failing
TYPES OF IAH /ACS
WCACS, ANTWERP BELGIUM 2007

Primary Injury/disease of abdomino-pelvic

region, surgical

Secondary Sepsis, capillary leak, burns,

medical

Recurrent ACS develops despite surgical

intervention
IAP INTERPRETATION
Pressure (mm Hg) Interpretation
0-5 Normal

5-10 Common in most ICU patients

> 12 (Grade I) Intra-abdominal hypertension

16-20 (Grade II) Dangerous IAH - begin non-

invasive interventions

>21-25 (Grade III) Impending abdominal compartment

syndrome - strongly consider
decompressive laparotomy
PHYSIOLOGIC INSULT/CRITICAL
ILLNESS
Ischemia Inflammatory response

Fluid resuscitation
Capillary leak

Tissue Edema
(Including bowel wall and mesentery)

Intra-abdominal hypertension
CAUSES OF INTRA-ABDOMINAL PRESSURE
(IAP) ELEVATION

Major abdominal / retroperitoneal problem

Ischemic insult / SIRS requiring fluid resuscitation

with a positive fluid balance of 5 or more liters
within 24 hours (10 lb weight gain)
MANAGEMENT OF IAH AND ACS
ABDOMINAL PERFUSION PRESSURE (APP)

APP = MAP IAP

Abdominal perfusion pressure reflects

actual gut perfusion better than IAP alone

Optimizing APP to > 60 mm Hg should

probably be primary endpoint
IAH/ACS MANAGEMENT:
DECOMPRESSIVE LAPAROTOMY
DECOMPRESSIVE LAPAROTOMY

Delay in abdominal decompression

may lead to intestinal ischemia
Decompress early!
INTRA-ABDOMINAL PRESSURE
MONITORING
INTRA-ABDOMINAL PRESSURE
MONITORING
Bladder pressure monitoring through the Foley
catheter is:
The current standard for monitoring abdominal
pressures (Consensus, World Congress ACS Dec 2004)
Comparableto direct intraperitoneal pressure
measurements, but is non-invasive (Fusco 2001,
Davis 2005, Risin 2006, Schachtrupp 2006)

More reliable and reproducible than clinical

judgment (Kirkpatrick, CJS 2000; Sugrue World J Surg 2002)
HOME MADE PRESSURE TRANSDUCER
TECHNIQUE
Home-made assembly:
Transducer
2 stopcocks
1 60 ml syringe,
1 tubing with saline bag
spike / luer connector
1 tubing with luer both
ends
1 needle / angiocath
Clamp for Foley
Assembled sterilely in
proper fashion
Dr. A.H. Kuncoro

ABDOMINAL COMPARTMENT SYNDROME

PEDIATRIC
1. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts
on Intra-abdominal Hypertension and Abdominal Compartment Syndrome, II: recommendations.
Intensive Care Med. 2007;33(6):951-962.
2. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts
on Intra-abdominal Hypertension and Abdominal Compartment Syndrome, I: definitions. Intensive
Care Med. 2006;32(11):1722-1732.
ALGORITM

3. World Society of the Abdominal Compartment Syndrome. Intra-abdominal hypertension assessment

(IAH) algorithm. http:// www.wsacs.org/Images/IAH_algorithm.pdf. Published 2007. Accessed
September 1, 2012.
Abdominal Compartment
Syndrome
Sustained intra-abdominal pressure
greater than 20 mm Hg (with or without
abdominal perfusion pressure <60 mm
Hg)

1. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts
on Intra-abdominal Hypertension and Abdominal Compartment Syndrome, II: recommendations.
Intensive Care Med. 2007;33(6):951-962.
2. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts
on Intra-abdominal Hypertension and Abdominal Compartment Syndrome, I: definitions. Intensive
Care Med. 2006;32(11):1722-1732.
MEASUREMENT ACS
MANAGEMENT ACS
Evacuate the intraluminal contents of the intestines by using
gastric suctioning, rectal enemas,and gastroprokinetic and
coloprokinetic agents
Evacuate the intra-abdominal space-occupying abnormalities to
treat extraluminal pathological changes such as ascites,
hemoperitoneum, or pneumoperitoneum, which mayrequire
procedures such as paracentesis.20,44
Optimize fluid administration by using goal-directed therapies.
Use of diuretics and continuous renal replacement therapy may
be helpful in reducing fluid overload and organ, tissue, and
abdominal wall edema contributing to IAH
Laparotomy with postoperative open-abdomen management