Authors: F.

Iordache, Ioana Grinescu,

Alina Prodan, D. Surdeanu

History
Intraabdominal pressure (IAP) was, at first,
measured via rectum (Braune, Germany
1865) and the interrelation between IAP
and respiratory failure was demonstrated
(Henricius, 1890).
Kron et al. (Ann Surg 1984) performed
surgical decompression in 11 cases with
oliguria.
Seven patients survived with renal function
restored.
In other 4 cases with renal failure but without
decompression died, all of them having renal
failure.

Background
Abdominal compartment syndrome (ACS) has
an incidence of 2-9%. Up to 15% of these
cases are registered in intensive care units.
ACS is present in 1% of polytrauma patients.
It seems that besides polytrauma the most
frequent cause of ACS is severe acute
pancreatitis (SAP).
Early prevention and early decompression in
those cases seems beneficial. In cases with
intraabdominal hypertension (IAH) and SAP
early decompression could be helpful. In these
cases the first 5 days are critical.

Objectives
The present study aimed analyzing the
presence of intraabdominal hypertension and
the development of abdominal compartment
syndrome in an intensive care unit patients
and the most frequent causes involved. Also,
the evolution of these cases was recorded in
regard with these data.
As a secondary objective we aim to
demonstrate and highlight the importance of
measuring and monitoring the intraabdominal
pressure in critical care patients and to
reevaluate the role of clinical assessment.
Material and method
A prospective study was designed.
Patients in ICU considered at risk of
developing ACS were included.
Measurement of intraabdominal
pressure was done by Foley method.
Clinical blind assessment of IAH was
performed by one of the authors.
Demographic, clinical and patient major
parameters were statistically analyzed.
In this study an elevated intraabdominal
pressure was considered above 12 mm
Hg (intraaabdominal hyperpressure
IAH)
ACS definition was the one agreed
internationally (WSACS).
Results and discussion
A total of 57 ICU patients were included. All of them
had Foley catheters. From this group 7 cases were
excluded, 2 cases because of refusal and 5 because
of transfers in other units.
Abdominal pressure was measured routinely once
daily and a blind comparison with clinical
assessment of IAH was also performed.
APACHE II and SOFA scores were calculated. In
SAP established criteria for severity were used.
Data regarding surgical intervention were collected.
There was a sex ratio of M:F of 1:1.4.
Average age was 55+18 ani with a median of 53
years.
Cases in study (50 patients)
Sex ratio - 1:1,4, Average age: 55+18 years
In our study the first cause of elevated
IAP was severe acute pancreatitis (SAP)
and trauma was second.
From 50 cases in study in 23 patients
(46%) an elevated IAP was recorded.
Intraabdominal pressure in 50
cases
Pressure
value
12-15 mm
Hg
15-20 mm
Hg
> 20 mm Hg Total
No. patients 23 16 11 50
% 46 32 22 100
Comparing data
Intraabdominal
pressure
Our study Efstathiou et al.
(2005)
I (12-15 mm Hg) 46% 58%
II (15-20 mm Hg) 32% 29%
III (>20 mm Hg) 22% 13%
In 11 patients an IAP above 20 mm Hg
was demonstrated. All these patients
were diagnosed with ACS. Ten were
male and only one woman developed
ACS. The difference can be explained
by the different pathologies involved.
In 29 cases a surgical procedure of
performed. In those with high IAP this
was also an indication for surgery, albeit
not alone. There were 15 deaths in
those admitted to surgery 9 of them
being with ACS (global mortality - 55%).
From 21 patients without surgery only 4
have survived (global mortality 81%)
Mortality for different values of
IAP
IAP Deaths (no.
patients)
Survivors (no.
patients)
Total (no.
patients)
12-15 mm Hg 14 9 23
15-20 mm Hg 10 6 16
>20 mm Hg
(ACS)
8 3 11
Total 32 18 50
Mortality in patients with
surgical procedure performed
(aetiology)
Mortality is correlated with IAP value but
the pathology involved is also an
important factor into the equation. The
mortality in cases with ACS in this study
was 73%. Hence, prevention of ACS is
extremely important.
Clinical assessment of IAP Vs
intravesical measurement (no.
patients)
Clinical assessment of IAP was blindly
done by one of the authors (FI). Clinical
assessment of IAP was correct in 71%
(35 cases) but an important number of
cases with high IAP were missed. As
others have proved, based on our data
we consider clinical evaluation
unreliable in the assessment of IAP.
In patients with SAP with 2 exception all
were having an IAP over 15 mm Hg. As
a matter fact the main aetiology
registered in our cases was SAP. We
can only speculate, although others
have demonstrated, that a high IAP is
an useful tool in indicating early
decompression.
From the 12 patients with SAP in 10
cases a surgical procedure was
performed.
There were 9 deaths in this subgroup.
Prevalence of ACS in SAP
No. of patients with
SAP and IAP 12-
15mm Hg
No. of patients with
SAP and IAP >20mm
Hg
Total
2 (17%) 10 (83%) 12
Vacuum pack
Conclusion
Severe acute pancreatitis and trauma are
the main causes of abdominal
compartment syndrome.
Objective measurement of the abdominal
pressure is mandatory for establishing IAH
diagnostic, clinical assessment being
inadequate.
Measuring IAP is the main diagnostic step
in preventing ACS or deciding for
decompression therapy.