Abdominal compartment syndrome: pathophysiology and definitions

Abstract

"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.

Figure 1

Pathophysiologic Implications of Intra-abdominal Hypertension. The effects of intra-abdominal hypertension are not limited just to the intra-abdominal organs, but rather have an impact either directly or indirectly on every organ system in the body. ICP – intracranial pressure; CPP – cerebral perfusion pressure; ITP – intrathoracic pressure; IVC – inferior vena cava; SMA – superior mesenteric artery; pHi – gastric intramuscosal pH; APP – abdominal perfusion pressure; PIP- peak inspiratory pressure; Paw – mean airway pressure; PaO₂ – oxygen tension; PaCO₂ – carbon dioxide tension; Qs/Qt – intrapulmonary shunt; Vd/Vt – pulmonary dead space ; CO – cardiac output; SVR – systemic vascular resistance; PVR – pulmonary vascular resistance; PAOP – pulmonary artery occlusion pressure; CVP – central venous pressure; GFR – glomerular filtration rate.