Abdominal compartment syndrome

Hepatorenal Syndrome-Novel Insights into Diagnostics and Treatment

Hepatorenal syndrome (HRS) is a disorder associated with cirrhosis and renal impairment, with portal hypertension as its major underlying cause. Moreover, HRS is the third most common cause of acute kidney injury, thus creating a major public health concern. This review summarizes the available information on the pathophysiological implications of HRS. We discuss pathogenesis associated with HRS. Mechanisms such as dysfunction of the circulatory system, bacterial infection, inflammation, impaired renal autoregulation, circulatory, and others, which have been identified as critical pathways for development of HRS, have become easier to diagnose in recent years. Additionally, relatively recently, renal dysfunction biomarkers have been found indicating renal injury, which are involved in the pathophysiology of HRS. This review also summarizes the available information on the management of HRS, focusing on vasoconstrictive drugs, renal replacement therapy, and liver transplant together with currently being investigated novel therapies. Analyzing new discoveries for the underlying causes of this condition assists the general research to improve understanding of the mechanism of pathophysiology and thus prevention of HRS.

Abdominal compartment syndrome complicating necrotizing enterocolitis: A case report

Introduction

There are several disease entities subsumed under the heading Necrotizing Enterocolitis (NEC):

1

The infectious enterocolitis that causes bowel necrosis.

2

Spontaneous Intestinal Perforation which is linked to the use of Indocin to hasten closure of a patent ductus arteriosus (PDA); the perforation occurs in bowel that is well perfused and viable.

3

Perforations that occur in bowel that is obstructed by thick or inspissated meconium (Awolaran and Sheth, Sept 2021) [1].

4

The uncommon variant that is associated with the abdominal compartment syndrome.

Case report

A case is presented in which a preemie suddenly developed massive abdominal distension. The neonatologist embarked upon the usual work-up and therapeutic interventions but was stymied by the inability to pass an orogastric tube to relieve the abdominal distension.

Discussion

The purpose of this report is not to criticize the neonatologist, but to emphasize the difference between this case, complicated by the abdominal compartment syndrome, and the usual case of NEC.

Conclusion

This is an unusual manifestation of NEC; and in my experience, it is uniformly fatal. Like many diseases with a fulminant course, our therapeutic efforts seem always too little, too late.

Perhaps, by calling attention to this unusual association, its dismal outcome may be altered.

•

A preemie may suddenly become septic and develop abdominal distension. Is this primary enterocolitis or ileus secondary to a septic focus elsewhere?

•

The abdominal radiographs may have a soap bubble appearance - generalized dilatation of the intestine and thinning of the bowel wall.

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In addition to being a sign of sepsis, abdominal distension may become a deleterious component in its pathogenesis. The abdominal compartment syndrome, by decreasing venous return and limiting diaphragmatic excursion, exacerbates cardiorespiratory failure.

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Neonatologists use familiar, safe modalities - pharmacopeia and ventilation - to prepare their fragile patients for surgery.

•

By diminishing the intra-abdominal pressure, laparotomy works in tandem with these modalities. Venous return and cardiac output are improved (metabolic acidosis); and diaphragmatic excursion and ventilation are facilitated (respiratory acidosis).

Hepatorenal syndrome: pathophysiology and evidence-based management update

Hepatorenal syndrome (HRS) is a functional renal failure that develops in patients with advanced hepatic cirrhosis with ascites and in those with fulminant hepatic failure. The prevalence of HRS varies among studies but in general it is the third most common cause of acute kidney injury (AKI) in cirrhotic patients after pre-renal azotemia and acute tubular necrosis. HRS carries a grim prognosis with a mortality rate approaching 90% three months after disease diagnosis. Fortunately, different strategies have been proven to be successful in preventing HRS. Although treatment options are available, they are not universally effective in restoring renal function but they might prolong survival long enough for liver transplantation, which is the ultimate treatment. Much has been learned in the last two decades regarding the pathophysiology and management of this disease which lead to notable evolution in the HRS definition and better understanding on how best to manage HRS patients. In the current review, we will summarize the recent advancement in epidemiology, pathophysiology, and management of HRS.

Variations of renal tissue oxygenation during abdominal compartment syndrome and sepsis

PURPOSE

This experimental study was designed to evaluate the renal tissue oxygenation under the coexistence of abdominal compartment syndrome and sepsis.

MATERIAL AND METHODS

Fourteen non-breed dogs were divided into two groups: the control group (8) and the study group (6). Sepsis was established with intravenous endotoxin infusion at 100μg/kg for over 30min. Insufflation of CO₂ in the peritoneal cavity was used for the increase in intra-abdominal pressure (IAP). A special catheter placed and fixed in the renal cortex at a depth of 3mm from the renal capsule was used for the measurement of renal tissue oxygenation.

RESULTS

Study parameters were recorded at the starting phase, at IAP of 15mmHg and 30mmHg and after decompression of the abdomen in the control group, and at the same intervals plus the induction of sepsis, prior to increasing abdominal pressure, in the study group. With the elevation of the IAP a reduction of renal tissue oxygenation presents itself, which is more pronounced in the presence of sepsis, especially for IAP over 15mmHg. Like other parameters, after abdominal decompression the renal tissue oxygenation returns to the initial levels, independently of sepsis.

CONCLUSIONS

The afferent arterioles vasoconstriction, which takes place during sepsis, and the intra-renal shunt, which occurs and leads to blood diversion to the medulla from the renal cortex due to the combination of intra-abdominal hypertension (IAH) and sepsis, seem to explain this finding.

Intra-abdominal Hypertension: An Important Consideration for Diuretic Resistance in Acute Decompensated Heart Failure

Fluid accumulation is the hallmark of heart failure decompensation. Fluid overload and congestion are associated with recurrent hospitalizations, poor quality of life, and increased mortality in heart failure. Despite the use of high-dose intravenous loop diuretic therapy, acutely decompensated heart failure patients may develop diuretic resistance. Diuretic refractoriness can be a result of elevated intra-abdominal pressure (IAP) in acutely decompensated heart failure. Increased renal venous and interstitial pressures in patients with elevated IAP may lead to renal impairment and diuretic resistance. Routine approaches such as sequential nephron blockade with a combination of loop and thiazide or thiazide-like diuretics, continuous diuretic infusion, and ultrafiltration may not be sufficient. Presented here is a case illustrating the importance of recognizing intra-abdominal hypertension in patients with diuretic resistance. Lowering IAP improves renal perfusion, renal filtration, and diuresis. When elevated, IAP is an easily reversible cause of diuretic resistance. Additionally, abdominal perfusion pressure can be used to guide therapy to reverse end-organ damage and avoid permanent renal replacement therapy.

Does Diastasis Width Influence the Variation of the Intra-Abdominal Pressure After Correction of Rectus Diastasis?

BACKGROUND

It has been demonstrated that there is an increase of intra-abdominal pressure (IAP) after correction of rectus diastasis.

OBJECTIVE

To evaluate the correlation between the diastasis width and IAP variation after the plication of the anterior rectus sheath.

METHODS

Seventeen patients met the inclusion criteria and were selected. The diastasis width was measured at three levels: 3 cm above the umbilicus, 2 cm above the umbilicus, and 2 cm below the umbilicus. Rectus sheath plication was performed in two layers: the first layer with separate stitches, and the second with continuous suture. The IAP was measured at two stages: before and after the correction of rectus diastasis. The distance between the iliac spines (IS) and that between the xiphoid process and pubic symphysis (XP) were measured. The abdominal surface index (ASI) was calculated using the formula: ASI = (IS × XP)/2. This index was used to determine the individual abdominal surface. The relative diastasis coefficient (RDC) was calculated using the formula: RDC = diastasis/ASI. These measurements were correlated to the IAP variation. The results of the IAP measurements obtained in each stage and the RDC values were compared, using the Pearson's linear correlation coefficient.

RESULTS

There was no statistically significant correlation between the IAP variation and the RDC values at the three levels studied.

CONCLUSIONS

The diastasis width does not interfere with the increase of the IAP when a plication of the anterior aponeurosis is performed.

LEVEL OF EVIDENCE

3 Diagnostic.

Ventilatory function and intra-abdominal pressure in patients who underwent abdominoplasty with plication of the external oblique aponeurosis

BACKGROUND

After correction of rectus diastasis there is a change in the values obtained by spirometry in the first few postoperative days. In specific cases, a plication of the external oblique aponeurosis in addition to plication of the anterior rectus sheath is indicated. Therefore, the aim of this study was to evaluate ventilatory function and intra-abdominal pressure (IAP) in patients who underwent abdominoplasty with the plication of the anterior rectus sheath, associated with an "L-shaped" plication of the external oblique aponeurosis.

METHODS

Eighteen female patients, classified as Nahas type III or B, were selected. Spirometry was performed preoperatively and on the 2nd, 7th, and 15th days after surgery. Intraoperatively, the IAP was measured at five points in the surgical procedure: (1) before skin incision, (2) after the plication of the rectus abdominis muscle, (3) after the L-plication of the aponeurosis of the external oblique, (4) after skin closure, and (5) after the use of a compressive garment.

RESULTS

There was a significant reduction in spirometry values after surgery. There was no correlation between body mass index (BMI), pain, the increase of IAP, and the width of diastasis and changes in spirometry (p ≤ 0.05) in any of the postoperative evaluations.

CONCLUSION

Spirometric parameters change on the 2nd and 7th postoperative days and tend to normalize on the 15th day. Postoperative pain, BMI, and increased IAP are not related to these changes. The use of compressive garments increases the IAP.

Recognition and management of abdominal compartment syndrome among German pediatric intensivists: results of a national survey

INTRODUCTION

Several decades ago, the beneficial effects of goal-directed therapy, which include decompressive laparotomy (DL) and open abdomen procedures in cases of intra-abdominal hypertension (IAH) in children, were proven in the context of closures of abdominal wall defects and large-for-size organ transplantations. Different neonatologic and pediatric disease patterns are also known to be capable of increasing intra-abdominal pressure (IAP). Nevertheless, a considerable knowledge transfer regarding such risk factors has hardly taken place. When left undetected and untreated, IAH threatens to evolve into abdominal compartment syndrome (ACS), which is accompanied by a mortality rate of up to 60% in children. Therefore, the present study looks at the recognition and knowledge of IAH/ACS among German pediatric intensivists.

METHODS

In June 2010, a questionnaire was mailed to the heads of pediatric intensive care units of 205 German pediatric hospitals.

RESULTS

The response rate was 62%. At least one case of IAH was reported by 36% of respondents; at least one case of ACS, by 25%. Compared with adolescents, younger critically ill children appeared to develop IAH/ACS more often. Routine measurements of IAP were said to be performed by 20% of respondents. Bladder pressure was used most frequently (96%) to assess IAP. Some respondents (17%) only measured IAP in cases of organ dysfunction and failure. In 2009, the year preceding this study, 21% of respondents claimed to have performed a DL. Surgical decompression was indicated if signs of organ dysfunction were present. This was also done in cases of at least grade III IAH (IAP > 15 mmHg) without organ impairment.

CONCLUSIONS

Although awareness among pediatricians appears to have been increasing over the last decade, definitions and guidelines regarding the diagnosis and management of IAH/ACS are not applied uniformly. This variability could express an ever present lack of awareness and solid prospective data.

Abdominal compartment syndrome - Intra-abdominal hypertension: Defining, diagnosing, and managing

Abdominal compartment syndrome (ACS) and intra-abdominal hypertension (IAH) are increasingly recognized as potential complications in intensive care unit (ICU) patients. ACS and IAH affect all body systems, most notably the cardiac, respiratory, renal, and neurologic systems. ACS/IAH affects blood flow to various organs and plays a significant role in the prognosis of the patients. Recognition of ACS/IAH, its risk factors and clinical signs can reduce the morbidity and mortality associated. Moreover, knowledge of the pathophysiology may help rationalize the therapeutic approach. We start this article with a brief historic review on ACS/IAH. Then, we present the definitions concerning parameters necessary in understanding ACS/IAH. Finally, pathophysiology aspects of both phenomena are presented, prior to exploring the various facets of ACS/IAH management.

Decompressive abdominal laparotomy for abdominal compartment syndrome in an unengrafted bone marrow recipient with septic shock

Objective. To describe a profoundly immunocompromised (panleukopenia) child with septic shock who developed abdominal compartment syndrome (ACS) and was successfully treated with surgical decompression. Design. Individual case report. Setting. Pediatric intensive care unit of a tertiary children's hospital. Patient. A 32-month-old male with Fanconi anemia who underwent bone marrow transplantation (BMT) 5 days prior to developing septic shock secondary to Streptococcus viridans and Escherichia coli ACS developed after massive fluid resuscitation, leading to cardiopulmonary instability. Interventions. Emergent surgical bedside laparotomy and silo placement. Measurements and Main Results. The patient's cardiopulmonary status stabilized after decompressive laparotomy. The abdomen was closed and the patient survived to hospital discharge without cardiac, respiratory, or renal dysfunction. Conclusions. The use of laparotomy and silo placement in an unengrafted BMT patient with ACS and septic shock did not result in additional complications. Surgical intervention for ACS is a reasonable option for high risk, profoundly immunocompromised patients.

Abdominal compartment syndrome: pathophysiology and definitions

"Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous system function. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. A thorough understanding of the pathophysiologic implications of elevated intra-abdominal pressure is fundamental to 1) recognizing the presence of intra-abdominal hypertension and abdominal compartment syndrome, 2) effectively resuscitating patients afflicted by these potentially life-threatening diseases, and 3) preventing the development of intra-abdominal pressure-induced end-organ dysfunction and failure. The currently accepted consensus definitions surrounding the diagnosis and treatment of intra-abdominal hypertension and abdominal compartment syndrome are presented.

Use of power Doppler ultrasound to monitor renal perfusion during burn shock

BACKGROUND

Renal cortical blood flow can be quantified by means of power Doppler ultrasound (PDUS) image analysis. We hypothesized that renal cortical perfusion, estimated by PDUS image intensity (PDUSII), would decrease during burn shock and improve during resuscitation in a porcine model.

METHODS

Eight anesthetized swine sustained a 75% scald injury. Resuscitation began 6h postburn. Renal cortical blood flow was measured directly using fluorescent microspheres (CORFLO), and was estimated noninvasively by PDUSII. PDUSII, CORFLO, and cardiopulmonary data were recorded every 2h.

RESULTS

PDUSII decreased significantly from preburn to postburn hour 6, and increased with resuscitation by hour 8. CORFLO correlated well with PDUS image intensity (n=48, r(2)=0.696) but poorly with urine output (n=48, r(2)=0.252).

CONCLUSION

PDUS in this study was superior to the urine output in assessing renal cortical microvascular blood flow during shock and resuscitation, and may be useful in the care of injured patients.

Avaliação da função respiratória em indivíduos submetidos à abdominoplastia

OBJETIVO: Avaliar a função respiratória em indivíduos submetidos à abdominoplastia, através de parâmetros espirométricos. MÉTODO: Estudo prospectivo de 33 mulheres hígidas e não tabagistas, submetidas à abdominoplastia, e com resultados normais para as radiografias de tórax realizadas antes e quatro dias após a operação. Foram realizadas provas espirométricas no pré-operatório, no quarto, 15o e no 30o dias de pós-operatório. RESULTADOS: Provas espirométricas evidenciaram que, exceto pela relação VFE1/CVF e FEF 25-75%/CVF, todos os demais parâmetros avaliados (CVF, VEF1, FEF 25-75% e PFE) se apresentaram significativamente diminuídos no 4o PO em relação aos valores pré-operatórios. Os valores de CVF e PFE se mostraram normalizados à avaliação realizada no 30o PO. Já os valores de VEF1 ainda se revelaram significativamente inferiores aos valores pré-operatórios mesmo na última avaliação. CONCLUSÕES: Ocorreu diminuição da função respiratória no 4º dia de pós-operatório com normalização até o 30º dia de pós-operatório.

Hyperacute abdominal compartment syndrome: an unrecognized complication of massive intraoperative resuscitation for extra-abdominal injuries

Primary and secondary abdominal compartment syndrome (ACS) are well-recognized entities after trauma. The current study describes a "hyperacute" form of secondary ACS (HACS) that develops intraoperatively while repair of extra-abdominal injuries is being carried out simultaneous with massive resuscitation for shock caused by those injuries. The charts of patients requiring abdominal decompression (AD) for HACS at time of extra-abdominal surgery at our level I trauma center were reviewed. The following data was gathered: age, Injury Severity Score (ISS), mechanism, resuscitation details, time to AD, time to abdominal closure, and outcome. All continuous data are presented as mean +/- standard error of mean. Hemodynamic and ventilatory data pre- and post-AD was compared using paired t test with significance set at P < 0.05. Five (0.13%) of 3,750 trauma admissions developed HACS during the 15-month study period ending February 2004. Mean age was 32 +/- 7 years, and mean ISS was 19 +/- 2. Four of five patients arrived in hemorrhagic shock (blunt subclavian artery injury, 1; chest gunshot, 1; gunshot to brachial artery, 1; stab transection of femoral vessels, 1) and were immediately operated upon. One of five patients (70% burn) developed HACS during burn wound excision on day 2. HACS developed after massive crystalloid (15 +/- 1.7 L) and blood (11 +/- 0.4 units) resuscitation during prolonged surgery (4.8 +/- 0.8 hours). Pre- versus post-AD comparisons revealed significant (P < 0.05) improvements in mean arterial pressure (55 +/- 6 vs 88 +/- 3 mm Hg), peak airway pressure (44 +/- 5 vs 31 +/- 2 mm Hg), tidal volume (432 +/- 96 vs 758 +/- 93 mL), arterial pH (7.16 +/- 0.0 vs 7.26 +/- 0.04), and PaCO2 (52 +/- 6 vs 45 +/- 6 mm Hg). There was no mortality among the group, and all patients underwent abdominal closure by fascial reapproximation in 2-5 days. Two (40%) of the five patients required extremity fasciotomy for compartment syndrome. HACS is a rare complication of massive resuscitation for extra-abdominal injuries. It should be considered in such patients in the face of unexplained hemodynamic and/or ventilatory decompensation. Prompt AD is life saving. Early abdominal closure is usually possible. Vigilance for compartment syndromes elsewhere in the body is warranted in any patient with HACS.)

The open abdomen: aetiology, classification and current management strategies

A new classification system has been devised for open abdominal wounds. This will help identify an appropriate management strategy, and indicate the associated morbidity and outcome. In all cases, early intervention is vital.

Compartment syndrome. The silent danger related to patient positioning and surgery

Compartment syndrome affecting the limbs is a well-documented condition and there are cases where it has become evident following surgery undertaken with the patient in the Lloyd Davies position. This article explores the contributory factors and the devastating effect it can have on the patient, and questions whether we practise evidence-based care when patients are undergoing certain types of surgery. It also discusses factors related to abdominal compartment syndrome, a condition usually affecting the critically ill patient.

Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation

BACKGROUND

The term secondary abdominal compartment syndrome (ACS) has been applied to describe trauma patients who develop ACS but do not have abdominal injuries. The purpose of this study was to describe major trauma victims who developed secondary ACS during standardized shock resuscitation.

METHODS

Our prospective database for standardized shock resuscitation was reviewed to obtain before and after abdominal decompression shock related data for secondary ACS patients. Focused chart review was done to confirm time-related outcomes.

RESULTS

Over the 30 months period ending May 2001, 11 (9%) of 128 standardized shock resuscitation patients developed secondary ACS. All presented in severe shock (systolic blood pressure 85 +/- 5 mm Hg, base deficit 8.6 +/- 1.6 mEq/L), with severe injuries (injury severity score 28 +/- 3) and required aggressive shock resuscitation (26 +/- 2 units of blood, 38 +/- 3 L crystalloid within 24 hours). All cases of secondary ACS were recognized and decompressed within 24 hours of hospital admission. After decompression, the bladder pressure and the systemic vascular resistance decreased, while the mean arterial pressure, cardiac index, and static lung compliance increased. The mortality rate was 54%. Those who died failed to respond to decompression with increased cardiac index and did not maintain decreased bladder pressure.

CONCLUSIONS

Secondary ACS is an early but, if appropriately monitored, recognizable complication in patients with major nonabdominal trauma who require aggressive resuscitation.

Abdominal compartment syndrome in children: experience with three cases

BACKGROUND/PURPOSE

Abdominal compartment syndrome (ACS) is defined as cardiopulmonary or renal dysfunction caused by an acute increase in intraabdominal pressure. Although the condition is well described in adults, particularly trauma patients, little is known about ACS in children.

METHODS

Three girls, ages 4, 5, and 5 years, were treated for ACS by silo decompression. Each child presented in profound shock, required massive fluid resuscitation, and had tremendous abdominal distension. The first child sustained a thoracoabdominal crush injury, underwent immediate celiotomy for splenic avulsion and a liver laceration, and required decompression 5 hours postoperatively. The second underwent ligation of her bluntly transected inferior vena cava; because of massive edema, her abdominal wall could not be closed, and prophylactic decompression had to be performed. The third presented with shock of unknown etiology, and ACS developed acutely with a bladder pressure of 26 mm Hg.

RESULTS

Respiratory, renal, and hemodynamic function improved immediately in all 3 patients after decompression. Subsequently, each child underwent abdominal wall reconstruction and recovered uneventfully.

CONCLUSIONS

ACS is a potentially lethal complication of severe trauma and shock in children. To prevent the development of renal or cardiopulmonary failure in these patients, decompression should be considered for acute, tense abdominal distension.

Acute abdominal compartment syndrome with pulseless electrical activity during colonoscopy with conscious sedation

We report an episode of acute abdominal compartment syndrome, with pulseless electrical activity, in a patient undergoing colonoscopic examination of a recently constructed mucus fistula. Associated clinical features of this acute abdominal compartment syndrome (tension pneumoperitoneum) were abdominal distention, which was very impressive, cardiopulmonary arrest, severe cyanosis, and progressive bradycardia.In general, increased intraabdominal pressure can have numerous adverse physiologic effects, which may include decreased cardiac output, altered ventilation-perfusion relationships, and decreased venous return. The magnitude of each effect likely depends on the magnitude of the increased intraabdominal pressure. Success with initial resuscitation efforts should not diminish further vigilance with these patients, as other problems may be discovered.

Secondary abdominal compartment syndrome: an underappreciated manifestation of severe hemorrhagic shock

OBJECTIVE

Abdominal compartment syndrome (ACS) has multiple well-described etiologies, but almost no attention has focused on ACS in the absence of abdominal injury. This study describes a secondary ACS that occurs after severe hemorrhagic shock with no evidence of abdominal injury.

METHODS

The trauma registry at a Level I trauma center was reviewed for a 13-month period beginning July 1, 1997.

RESULTS

During the study period, there were 46 of 1,216 intensive care unit admissions (4%) who required laparotomy and mesh closure of the abdominal wall because of visceral edema. In that subgroup, six patients (13% of mesh closures, 0.5% intensive care unit admissions) had hemorrhagic shock (5/1, blunt/penetrating trauma) but no evidence of intra-abdominal injury. Associated extremity compartment syndrome developed in two of six (33%). Overall mortality was four of six (67%), secondary to sepsis (n = 3), and head injury (n = 1). Time from admission to decompression averaged 3 hours in survivors and 25 hours in nonsurvivors (overall average = 18+/-9 hours). Resuscitation volume before abdominal decompression averaged 19+/-5 liters of crystalloid and 29+/-10 units of packed red blood cells. Bladder pressure averaged 33+/- 3 mm Hg. Decompression significantly improved peak inspiratory pressure (p < 0.003) and base deficit (p < 0.003).

CONCLUSION

ACS can occur with no abdominal injury; The incidence of secondary ACS was 0.5% in this cohort trauma intensive care unit patients, so it probably occurs more frequently than is currently appreciated. Because survivors were decompressed 20 hours before nonsurvivors, early recognition might improve outcomes. On the basis of these observations, we recommend that bladder pressures should be routinely checked and acted on appropriately when resuscitation volumes approach 10 liters of crystalloid or 10 units of packed red cells.

Gastrointestinal complications in the intensive care unit

Pathologic conditions affecting the abdomen are a significant cause of morbidity and mortality in the intensive care unit, but their importance is not widely recognized. This article presents several aspects of abdominal pathology that can occur in intensive care unit patients. This pathology may have a considerable impact on the prognosis and survival of the critically ill patient. The diagnostic contribution of laboratory tests and imaging is discussed. Conditions such as the abdominal compartment syndrome, acute mesenteric ischemia, gastrointestinal bleeding, diarrhea, abdominal sepsis, complications of entereal and parenteral nutrition, and ileus in critically ill patients are also reviewed.

Abdominal compartment syndrome: does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients

BACKGROUND: Abdominal compartment syndrome is defined as the adverse physiologic effects of increased intra-abdominal pressure. Prolonged, unrelieved pressure may lead to respiratory compromise, renal impairment, cardiac failure, shock, and death. Abdominal compartment syndrome is diagnosed by measuring intra-cystic pressure as a reflection of intra-abdominal pressure. To examine the validity of the technique, we conducted a prospective study in surgical patients by directly measuring bladder and abdominal pressures simultaneously during laparoscopic cholecystectomy using a previously described technique. RESULTS: In the present model, the bladder had higher baseline pressures than did the abdomen. Measurements across the bladder wall were not identical, but had high positive correlation coefficient when evaluated on an individual basis. Global analysis of the data for all patients showed a weak correlation coefficient. CONCLUSION: In the present study model, intra-cystic pressure did not reflect actual intra-abdominal pressure. In spite of some limitations in the study design, we feel that further research is warranted to identify other possible variables that may play a role in the relationship between the urinary bladder and the abdominal cavity pressures, providing better means for diagnosis of abdominal compartment syndrome.