title: Acute abdominal compartment syndrome: current diagnostic and therapeutic options.
abstract: BACKGROUND
  If untreated, the abdominal compartment syndrome (ACS) has a mortality of nearly 100 %. Thus, its early recognition is of major importance for daily rounds on surgical intensive care units. Intraabdominal hypertension (IAH) is a poorly recognized entity, which occurs if intraabdominal pressure arises >12 mmHg. Measurement of the intravesical pressure is the gold standard to diagnose IAH, which can be detected in about one fourth of surgical intensive care patients.
  
  
  OBJECTIVE
  The aim of this manuscript is to outline the current diagnostic and therapeutic options for IAH and ACS. While diagnosis of IAH and ACS strongly depends on clinical experience, new diagnostic markers could play an important role in the future. Therapy of IAH/ACS consists of five treatment "columns": intraluminal evacuation, intraabdominal evacuation, improvement of abdominal wall compliance, fluid management, and improved organ perfusion. If conservative therapy fails, emergency laparotomy is the most effective therapeutic approach to achieve abdominal decompression. Thereafter, patients with an open abdomen require intensive care and are permanently threatened by the quadrangle of fluid loss, muscle proteolysis, heat loss, and an impaired immune function. As a consequence, complication rate dramatically increases after 8 days of open abdomen therapy.
  
  
  CONCLUSIONS
  Despite many efforts, the mortality of patients with ACS remains unacceptably high. Permanent clinical education and surgical trials will be necessary to improve the outcome of our critically ill surgical patients.
authors.affiliation: Department of General and Thoracic Surgery, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany. Andreas.Hecker@chiru.med.uni-giessen.de.
authors.forename: A
authors.initials: A
authors.lastname: Hecker
authors.affiliation: Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hecker
authors.affiliation: Medical Clinic II, Pulmonary and Critical Care Medicine, University Hospital of Giessen, Giessen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hecker
authors.affiliation: Department of General and Thoracic Surgery, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.
authors.forename: J G
authors.initials: JG
authors.lastname: Riedel
authors.affiliation: Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: M A
authors.initials: MA
authors.lastname: Weigand
authors.affiliation: Department of General and Thoracic Surgery, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Padberg
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D058107:Abdominal Wound Closure Techniques; D019299:Decompression, Surgical; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D007813:Laparotomy; D054843:Negative-Pressure Wound Therapy; D013526:Surgical Mesh
keywords: Acute compartment syndrome; Intraabdominal hypertension; Intraabdominal pressure; Open abdomen