Abdominal compartment syndrome: Often overlooked conditions in medical intensive care units

Abstract

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome are well recognized entities among surgical patients. Nevertheless, a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units (ICU) and has been widely recognized as an independent risk factor for mortality. It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality. Frequently it is underdiagnosed and undertreated in this patient population. Elevated intra-abdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure. When intraabdominal hypertension is not promptly recognized and treated, it leads to abdominal compartment syndrome, multiorgan dysfunction syndrome and death. Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis, shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension. This article presents an overview of the epidemiology, definitions, risk factors, pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Keywords: Intra-abdominal pressure; Intra-abdominal hypertension; Abdominal compartment syndrome; Acute kidney injury; Large volume resuscitation; Open abdomen; Bladder pressure; Medical intensive care unit

Core tip: Intra-abdominal hypertension and abdominal compartment syndrome are very common in medical intensive care unit. Recognizing the risk factors for the development of intra-abdominal hypertension, timely measurement of intra-abdominal pressure and promptly implementing the resuscitation strategies can significantly reduce the morbidity and mortality associated with abdominal compartment syndrome.