Abdominal Compartment Syndrome. By Sharra Way - Bingham, RN. ? What it is ?. A disease process that dramatically increases organ failure and death for medical and surgical ICU patients.
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Abdominal Compartment Syndrome
Sharra Way - Bingham, RN
? What it is ?
A disease process that dramatically increases organ failure and death for medical and surgical ICU patients
Abdominal Compartment syndrome occurs as a result of the accumulation of fluid in the abdominal space from trauma or surgical procedures, or the increasing of abdominal contents due to tissue edema from an inflammatory process or massive fluid resuscitation or from tumor growth
As this pressure increases within the abdomen capillary perfusion is compromised and tissue ischemia and/or death occurs
If undetected or untreated multi-organ failure and patient death may ensue
What is a normal intra-abdominal pressureorIAP
This is the pressure within the abdominal cavity
5 – 7 mmHg is normal in a critically ill adult
(Including bowel wall and mesentery)
Measuring Intra-Abdominal Pressure
IAH/ACS Assessment algorithm from
World Society of Abdominal Compartment Syndrome (WSACS)
Most technically reliable
Correlate closely with pressures measured directly in the abdominal cavity
Transduced through a Foley catheter
Early detection via frequent monitoring of at risk patients
Screen for IAH/ACS in new ICU admissions with new or progressive organ failure
Look for trends of increasing abdominal pressures
Preserve organ perfusion and treat clinical conditions with grades I & II
Early surgical consultations for at risk patients
Early intervention for ACS or Grade III
Anticipate emergent surgical interventions to prevent tissue damage/death
The “Bogata Bag” – A 3 L IV bag, open and sterilized and applied to the abdominal opening
Another Excellent Reference,
IAH/ACS Management Algorithm from
Identify At risk patient populations
abdominal trauma/major burns
Perform an accurate assessment of abdominal pressure using Abdominal bladder pressure monitoring via Foley catheter or AbViser – Wolfe Torey Medical
Anticipate patient interventions/outcomes
Case Study - 63 Y.O. male pt with pancreatitis is admitted to the ICU. Pt has history of gallbladder disease, COPD and ETOH abuse. He has been without ETOH reportedly for approximately 24 hrs. VS upon admission are T 38.0, HR 130, BP 90/62, MAP 61, RR 30 – 34 & O2 sat of 91% on 100% NRB, wt approximately 125 kg. His breathing is labored and he has c/o SOB. He is also mildly agitated & resistive to O2 therapy with Bi-Pap. His lung sounds are diminished bilaterally. Denies recent increase in cough. His abdomen is firm and distended. States unknown last BM but + for N/V.
Does this patient need IAP monitoring?
Is he at risk?
What could you use as a reference if you were unsure?
After consulting with your attending MD, it is decided that a baseline ABP reading would be appropriate for this patient. Your initial ABP is 15mmHg.
Does this value represent intra-abdominal hypertension or abdominal compartment syndrome?
What is his APP based on his MAP and IAP?
What grade would you give this value?
Why is this patient at risk?
How would you proceed?
After reporting the findings to the resident, serial ABP readings are ordered Q6 HR. His SBP continues to remain low with a map consistently < 65 & his respiratory status continues to deteriorate. The resident also orders another fluid bolus.
After collaboration with the medical team the decision is made to intubate as his O2 sats continue to drop and RR rate cont. to increase. After intubation and appropriate sedation, the patient continues to have an increasingly firm abdomen, increased HR and decreased SBP and map <60 despite added norepinephrine. He is also now vented with a respiratory rate of 24 – 30 and has become increasingly agitated. His urine output for the last 2 hours is 30 ml. You repeat the ABP prior to the 4 hr interval and you notice that his ABP value has risen to 20 after two separate measurements. What could you expect at this point?