Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome.
Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have detrimental effects on all organ systems and are associated with significant morbidity and mortality. In recent years, the diagnosis and management of these syndromes has evolved tremendously, and the importance of comprehensive strategies to reduce intraabdominal pressure (IAP) has been recognized. All clinicians should be aware of the risk factors that predict the development of IAH/ACS, the appropriate measurement of IAP, and the current resuscitation options for managing these highly morbid syndromes. The nonoperative management of IAH/ACS can be summarized using five therapeutic goals: evacuate intraluminal contents, evacuate intraabdominal space-occupying lesions, improve abdominal wall compliance, optimize fluid administration, and optimize systemic and regional tissue perfusion. Surgical intervention through open abdominal decompression should immediately be pursued for patients with progressive IAH, end-organ dysfunction, and failure that is refractory to these nonoperative therapies. This comprehensive management strategy has been demonstrated to improve patient survival and long-term outcome.
Department of Surgical Education, Orlando Regional Medical Center, 86 West Underwood Street, Suite 201, Orlando, FL 32806, USA. michael.cheatham@orhs.org
Michael L
ML
Cheatham
D034841:Abdominal Cavity; D034861:Abdominal Wall / Q000503:physiopathology; D001825:Body Fluid Compartments; D002985:Clinical Protocols; D003161:Compartment Syndromes / Q000503:physiopathology / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D006874:Hydrostatic Pressure; D008150:Lower Body Negative Pressure; D008991:Monitoring, Physiologic / Q000379:methods; D009102:Multiple Organ Failure / Q000517:prevention & control; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors