Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment
Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by
various events that produce intra-abdominal hypertension. The most common cause is blunt
abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and
ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria
from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome.
The consequences of abdominal compartment syndrome are profound and affect many vital
body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ
dysfunction and to avoid progression to ACS. Many treatment options are available and are
often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema,
sedation, body position). Some of the newer treatments are very promising options in specific
patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.
Emerg Med Open J. 2015; 1(2): 46-63. doi: 10.17140/EMOJ-1-110