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Abdominal compartment syndrome: pathophysiology and definitions.

Cheatham ML - Scand J Trauma Resusc Emerg Med (2009)

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida 32806, USA. michael.cheatham@orlandohealth.com

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.

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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.
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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.

Mentions: Although initially recognized over 150 years ago, the pathophysiologic implications of elevated intra-abdominal pressure (IAP) have essentially been rediscovered only within the past two decades [1-3]. An explosion of scientific investigation and accumulation of clinical experience has confirmed the significant detrimental impact of both "intra-abdominal hypertension" (IAH) (see figure 1), the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome" (ACS), the development of IAH-induced organ-dysfunction and failure, among the critically ill [4,5]. IAH has been identified as a continuum of pathophysiologic changes beginning with regional blood flow disturbances and culminating in frank end-organ failure and the development of ACS. ACS has been identified to be a cause of significant morbidity and mortality among critically ill surgical, medical, and pediatric patients. Previously present, but significantly under-appreciated, IAH and ACS are now recognized as common occurrences in the intensive care unit (ICU) setting [6-16]. Elevated IAP has been identified as an independent predictor of mortality during critical illness and likely plays a major role in the development of multiple system organ failure, a syndrome which has plagued ICU patients and physicians for decades [8,17,18].


Abdominal compartment syndrome: pathophysiology and definitions.

Cheatham ML - Scand J Trauma Resusc Emerg Med (2009)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654860&req=5

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.
Mentions: Although initially recognized over 150 years ago, the pathophysiologic implications of elevated intra-abdominal pressure (IAP) have essentially been rediscovered only within the past two decades [1-3]. An explosion of scientific investigation and accumulation of clinical experience has confirmed the significant detrimental impact of both "intra-abdominal hypertension" (IAH) (see figure 1), the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome" (ACS), the development of IAH-induced organ-dysfunction and failure, among the critically ill [4,5]. IAH has been identified as a continuum of pathophysiologic changes beginning with regional blood flow disturbances and culminating in frank end-organ failure and the development of ACS. ACS has been identified to be a cause of significant morbidity and mortality among critically ill surgical, medical, and pediatric patients. Previously present, but significantly under-appreciated, IAH and ACS are now recognized as common occurrences in the intensive care unit (ICU) setting [6-16]. Elevated IAP has been identified as an independent predictor of mortality during critical illness and likely plays a major role in the development of multiple system organ failure, a syndrome which has plagued ICU patients and physicians for decades [8,17,18].

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida 32806, USA. michael.cheatham@orlandohealth.com

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.

Show MeSH
Related in: MedlinePlus