Abdominal compartment syndrome: current problems and new strategies.
BACKGROUND
Abdominal compartment syndrome (ACS) is a difficult entity with two main problems during its course: (1) survival of the patient during the early period and (2) closure of the open wounds during the late period. In this study we evaluated the decision to decompress according to the level of intraabdominal pressure (IAP) and analysis of any recurrent or persistent increase in IAP.


METHODS
A prospective study was undertaken on 119 patients with increased IAP. The IAP was measured daily by obtaining the bladder pressure. Patients were monitored via a central venous line; and vital signs, arterial blood gases, the Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II) score, and abbreviated mental tests were recorded. The suggestions of Meldrum et al. were taken as a guideline during the treatment. The sensitivity and specifity of IAP and APACHE II scores for different cutoff values were calculated using the receiver operating characteristic curve.


RESULTS
Hospital mortality was 33.6%, which increased with co-morbidities (p = 0.03). A cutoff value for IAP of 23 mmHg was considered an optimal point predicting mortality. The IAP within the first 3 days for patients who died was higher than the cutoff value. For patients with IAP of 15 to 25 mmHg, nonsurgical therapy increased the rate of mortality (odds ratio 5.2, 95% confidence interval 1.0-27.7; p = 0.03).


CONCLUSIONS
In patients with ACS emergency, it is recommended that decompressive laparotomy to be performed even if the IAP falls below 25 mmHg. For patients with IAP levels higher than 25 mmHg, the IAP should be meticulously brought below the cutoff level during the postoperative period.
Parsak
Cem Kaan
CK
Department of General Surgery, Cukurova University, School of Medicine, 01330, Balcali, Adana, Turkey. cparsak@cu.edu.tr
Seydaoglu
Gulsah
G
Sakman
Gurhan
G
Acarturk
T Oguz
TO
Karakoc
Emre
E
Hanta
Ismail
I
Alparslan
Ali Haydar
AH
Satar
Salim
S
D018806:APACHE; D000005:Abdomen / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003161:Compartment Syndromes / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology