Sindrome Compartimental

Abdominal compartment syndrome
Michael Lee Cheatham
Surgical Intensive Care Units, Orlando Regional Medical Center, Orlando, Florida, USA Correspondence to Michael Lee Cheatham, MD, FACS, FCCM, Department of Surgical Education, Orlando Regional Medical Center, 86 West Underwood Street, Suite 201, Orlando, FL 32806, USA Tel: +1 407 841 5296; fax: +1 407 649 6838; e-mail:michael.cheatham@orlandohealth.com Current Opinion in Critical Care 2009, 15:154–162

Purpose of review Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the pathophysiologic implications of elevated intraabdominal pressure (IAP), have detrimental effects on all organ systems and are associated with significant morbidity and mortality. Within the past few years, the diagnosis and managementof these syndromes have evolved tremendously. Recent findings Consensus definitions and recommendations for the diagnosis and management of IAH/ACS have been proposed. Risk factors for IAH/ACS have been clearly defined. The timing and techniques for IAP measurement have been further described. A comprehensive evidence-based medical and surgical approach to the treatment of IAH/ACS has been developed.Summary Liberal IAP measurement in the presence of known risk factors combined with implementation of an evolving and comprehensive resuscitation strategy have resulted in significant improvements in both short and long-term outcome for patients who develop IAH/ACS. All clinicians should be aware of the risk factors that predict development of IAH/ACS, the appropriate measurement of IAP, and thecurrent resuscitation options for managing these highly morbid syndromes. Keywords abdominal compartment syndrome, intraabdominal hypertension, intraabdominal pressure
Curr Opin Crit Care 15:154–162 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 1070-5295

Introduction
Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the pathophysiologic manifestationsof elevated intraabdominal pressure (IAP), represent significant causes of morbidity and mortality [1–9,10 –22]. Implementation of bedside IAP monitoring, creation of consensus definitions and recommendations, and application of an evolving management strategy have resulted in significant improvements in patient survival [23,24,25,26]. The incidence of IAH/ACS, principles and techniques forIAP monitoring, and current fluid resuscitation guidelines were recently reviewed in this journal [27]. The following complementary article addresses state-of-the-art management of patients with IAH/ACS and identifies recent cuttingedge improvements.

make a standardized therapeutic approach to these complex patients difficult. Several fundamental management principles, however, remain constantacross all patient populations. Although surgical decompression is widely and erroneously considered the only treatment for IAH/ ACS, nonoperative medical management strategies play a vital role in the prevention and treatment of IAP-induced organ dysfunction and failure [6–8,10,27,28,29]. Appropriate management of IAH/ACS is based upon four general principles: (1) serial monitoring of IAP, (2)optimization of systemic perfusion and organ function, (3) institution of specific medical interventions to reduce IAP and the end-organ consequences of IAH/ACS, (4) prompt surgical decompression for refractory IAH. Over 200 clinical trials, case reports/series, or review articles on IAH/ACS have been published within the past 2 years. The consensus definitions and recommendations recentlypublished by the World Society of the Abdominal Compartment Syndrome (WSACS) represent a summation of our current understanding of IAH/ACS
DOI:10.1097/MCC.0b013e3283297934

Current management of intraabdominal hypertension/abdominal compartment syndrome
The multiple disparate patient populations at risk for IAH/ACS, combined with numerous causative factors,
1070-5295 ß 2009 Wolters Kluwer Health |...