Abdominal compartment syndrome

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Intensive Care Med (2003) 29:1177–1181 DOI 10.1007/s00134-003-1806-z

B R I E F R E P O RT

Bart L. De Keulenaer Adelard De Backer Dirk R Schepens Ronny Daelemans Alexander Wilmer Manu L. N. G. Malbrain

Abdominal compartment syndrome related to noninvasive ventilation

Received: 11 September 2002 Accepted: 5 April 2003 Published online: 22 May 2003 © Springer-Verlag 2003

B. L. DeKeulenaer (✉) Makrylos CCT, 0810 Brinkin, Northern Territory, Australia e-mail: bdekeul@hotmail.com Tel.: +61-8-89271143 Fax: +61-4-01116227 B. L. De Keulenaer · D. R. Schepens R. Daelemans · M. L. N. G. Malbrain Medical Intensive Therapy Unit, General Hospital Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium A. De Backer Radiology Department, General Hospital Stuivenberg, LangeBeeldekensstraat 267, 2060 Antwerp, Belgium A. Wilmer Medical Intensive Care Unit, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium

Abstract Objective: To study the effects of noninvasive positive pressure ventilation (NIPPV) on intraabdominal pressure. Design and setting: Single case report from a tertiary teaching hospital. Patients and methods: A 65-year-old man who experienceda sudden respiratory and cardiovascular collapse during NIPPV. This was caused by gastric overdistension due to aerophagia followed by raised intra-abdominal pressure leading to intra-abdominal hypertension and abdominal compartment syndrome. Results: The respiratory and cardiovascular problems resolved immediately after the introduction of a nasogastric tube. This resulted in normalization ofIAP. Conclusions: This is the first case reported of an abdominal compartment syndrome related to NIPPV. Clinicians should be aware of this possible complication while using NIPPV.

Keywords Cardiovascular collapse · Noninvasive ventilation · Intra-abdominal pressure · Intra-abdominal compartment syndrome · Gastric distention

Case presentation
A 65-year-old obese man was admitted because ofdizziness and associated falls. He had a past medical history of cardiac bypass surgery, bowel cancer, non-insulin-dependent diabetes, and chronic bronchitis. Examination revealed fine crackles over both lungs with prolonged expirium. The abdomen was soft and tender. Initial arterial blood gas analysis on room air was normal. Full blood examination showed raised inflammatory parameters. Cardiacinvestigation showed normal left ventricular ejection fraction (66%). Atrial fibrillation (AF) was apparent on electrocardiography. Neurological investigation was normal. Two weeks later he was transferred to the ICU with rapid AF (149 bpm) and shortness of breath. Chest radiography revealed right lower lobe pneumoniae, and antibiotics were started. The AF

receded under treatment. Four days later hewas stable and transferred back to the ward. However, within 5 days he was readmitted with recurrent AF at 150 bpm and respiratory distress: respiratory rate (RR) of 33 breaths/min, with diffuse crackles and severe wheezing. Abdominal examination remained unremarkable. Nebulized bronchodilators were administered, as were intravenous corticosteroids and oxygen. Dyspnea worsened with deteriorationof arterial blood gasses: PaO2 60 mmHg, PaCO2 65 mmHg, HCO3 27.2 mmol/l, and pH 7.25 while on 1.5l/min oxygen via nasospecs. Due to respiratory acidosis and clinical exhaustion (high RR) he was put on NIPPV with an inspiratory positive airway pressure (IPAP) initially of 14 but later 20 cmH2O and an expiratory positive airway pressure (EPAP) of 5 cmH2O. Since NIPPV was initially intermittent, anasogastric tube (NGT) was not placed. He

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Fig. 1 A closed needle-free revised method for measurement of intra-abdominal pressure. A Foley catheter is sterile placed and the urinary drainage system connected. Using a sterile field and gloves, the drainage tubing is cut 40 cm after the culture aspiration port. A ramp (Manifold set, Pvb Medizintechnik, Kirchseeon, Germany, or anther...
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