1 Abdominal Compartment Syndrome

Question 1

Define IAH

ACS

Answer 1

Normal IAP in ICU 5-7mmHg

IAH >12mmHg continously or on repeat measure

ACS >20mmHg w/ Organ dysfunction

Question 2

How can we measure IAP

Answer 2

1. Indirect

Transduction via urinary bladder catheter -
measure intravesical pressure

• 100ml sterile saline intro into bladder
• drainage bag reconnect and x clamped
• 16g needle connected manometer or pressure transducer via culture port site of catheter
• Patient remains supine & zero point is symphysis pubs

Directly

Needle introduced into abdomen
can be during laparoscopy

Question 3

Management of ACS

Abdominal compartment

Answer 3

Mortality >40%
prompt decisive imperative
unRx - mortality higher

Priority optimise physiological & metabolic status
Restore and improve vital organ function
-aggresive iv fluid resus
- inotrope +/- pressore

Optmise ventilator
deliver adequate vent w/out ALI

Adequate:
sedation / anaglesia
muscle relaxation - avoid cough strain peritoneal irritation

Avoid prone

Question 4

More mx

Answer 4

?Consider RRT
-severe acidosis / electrolyte imbal

Gastric decompression
prokinetics

Drainage of collections

Surgical decompression & laparostomy

Ultimate definitive Rx success - improvement physiological parameter depending cause

Negative pressure suction dressing

Question 5

Complications ACS

Abdo compartment

Answer 5

Complications - 
Mx open abdo ICU
fluid loss
skin care
fistula formation