ABDOMINAL COMPARTMENT SYNDROME AND THE OPEN ABDOME

ABDOMINAL COMPARTMENT SYNDROME AND THE OPEN ABDOMEN

Raised intra-abdominal pressure has far-reaching conse - quences for the patient; the syndrome that results is known as ACS. ACS is a major cause of morbidity and mortality in the critically ill patient and its early recognition is essential ( Table 29.8 ). In all cases of abdominal trauma in w hich the development of ACS in the immediate postoperative phase is considered a risk, the abdomen should be left open and managed as for damage control surgery . -

TABLE 29.8 Effect of raised intra-abdominal pressure on individual organ function. System Effect Renal Increase in renal vascular resistance leading to a reduction in glomerular /f_i ltration rate and impaired renal function Cardiovascular Decrease in venous return resulting in decreased cardiac output because of both a reduction in preload and an increase in afterload Respiratory Increased ventilation pressures because of splinting of the diaphragm, decreased lung compliance and incr eased airway pressures Visceral effects Reduction in visceral perfusion Intracranial effects Severe rises in intracranial pressures

ABDOMINAL COMPARTMENT SYNDROME AND THE OPEN ABDOMEN

Raised intra-abdominal pressure has far-reaching conse - quences for the patient; the syndrome that results is known as ACS. ACS is a major cause of morbidity and mortality in the critically ill patient and its early recognition is essential ( Table 29.8 ). In all cases of abdominal trauma in w hich the development of ACS in the immediate postoperative phase is considered a risk, the abdomen should be left open and managed as for damage control surgery . -

TABLE 29.8 Effect of raised intra-abdominal pressure on individual organ function. System Effect Renal Increase in renal vascular resistance leading to a reduction in glomerular /f_i ltration rate and impaired renal function Cardiovascular Decrease in venous return resulting in decreased cardiac output because of both a reduction in preload and an increase in afterload Respiratory Increased ventilation pressures because of splinting of the diaphragm, decreased lung compliance and incr eased airway pressures Visceral effects Reduction in visceral perfusion Intracranial effects Severe rises in intracranial pressures