The abdominal compartment syndrome: Clinical relevance

Increased intra-abdominal pressure (IAP) may occur in a number of differentsituations encountered by intensivists, such as tense ascites, abdominalhemorrhage, use of military antishock trousers, abdominal obstruction, duringlaparoscopy, large abdominal tumors and peritoneal dialysis.1-3 Both clinical andexperimental evidence indicate that increased IAP may adversely affect cardiac,renal, respiratory and metabolic functions.1-5 Despite this, increased IAP israrely recognized and treated in Intensive Care Unit (ICU) settings. Thereappears to be two reasons for this: the physiologic consequences of increased IAPare not well know, to most physicians and, more importantly, the capability ofeasily measuring IAP has not been well documented. In this chapter, we willdiscuss: 1) the different methods proposed to evaluate IAP in ICU; 2) thephysiopathological consequences of increased IAP; 3) the existing clinical dataabout IAP in critically ill patients. Considering overall our data, we canconclude that: 1) different techniques are available at the bedside to estimatethe IAP; 2) the IAP ranges between 10 and 20 cmH2O, substantially increasedcompared to normal subjects. Most of the patients have IAH, while few of them(<5%) present clinical characteristics of ACS; 3) the IAP is different amongdifferent categories of patients and its increase is not limited to surgicalpatients only; 4) the increase in IAP appears to influence respiratory function, homodynamic, kidney, gut and brain physiology; 5) the IAP seems to be correlated with severity scores but its relation to mortality is controversial; 6) theroutine measurements of IAP by means of bladder pressure are not associated with an increased rate of urinary tract infections.