Management of abdominal compartment syndrome and the open abdomen.
OBJECTIVE
The management of the abdominal compartment syndrome (ACS) and the open abdomen (OA) are important to improve survival after major vascular surgery, in particular ruptured abdominal aortic aneurysm (RAAA). The aim is to summarize contemporary knowledge in this field.


METHODS
The consensus definitions of the World Society of the Abdominal Compartment Syndrome (WSACS) that were published in 2006 and the clinical practice guidelines published in 2007 were updated in 2013. Structured clinical questions were formulated (modified Delphi method), and the evidence base to answer those questions was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines.


RESULTS
Most of the previous definitions were kept untouched, or were slightly modified. Four new definitions were added, including a definition of OA and of lateralization of the abdominal wall, an important clinical problem to approach during prolonged OA treatment. A classification system of the OA was added. Seven recommendations were formulated, in summary: Trans-bladder intra-abdominal pressure (IAP) should be monitored in patients at risk. Protocolized monitoring and management are recommended, and decompression laparotomy if ACS. When OA, protocolized efforts to obtain an early abdominal fascial closure, and strategies utilizing negative pressure wound therapy should be used, versus not. In most cases the evidence was graded as weak or very weak. In six of the structured clinical questions, no recommendation could be made.


CONCLUSIONS
This review summarizes changes in definitions and management guidelines of relevance to vascular surgery, and data on the incidence of ACS after open and endovascular aortic surgery.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. Electronic address: martin@bjorck.pp.se.
M
M
Björck
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
A
A
Wanhainen
D058107:Abdominal Wound Closure Techniques; D016638:Critical Illness; D019299:Decompression, Surgical; D057510:Endovascular Procedures; D004750:Enteral Nutrition; D000071938:Fasciotomy; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000503:physiopathology / Q000601:surgery*; D007813:Laparotomy; D054843:Negative-Pressure Wound Therapy
Abdominal aortic aneurysm; Abdominal compartment syndrome; Consensus guidelines; Grading of recommendations; Intra-abdominal hypertension; Open abdomen; Rupture; Temporary abdominal closure