ABDOMINAL COMPARTMENT SYNDROME TREATMENT GUIDELINES

ppt on abdominal compartment syndrome

1. ABDOMINAL COMPARTMENT SYNDROME Dr Anshuttam Mishra

2. It refers to organ dysfunction caused by intra abdominal hypertension . It may be under recognized as it primarily affects patients who are critically ill or it maybe incorrectly ascribed to progression of primary illness. Intra abdominal hypertension and abdominal compartment syndrome are distinct clinical entities and should not be used interchangeably.

3. Intra Abdominal Pressure It is a steady state pressure concealed within the abdominal cavity. For normal individuals, the pressure will be sub atmospheric to zero . In critically ill patients, an IAP of 4 – 8 mm Hg is considered normal. Patients with increased abdominal girth that developed slowly, eg – the morbidly obese and pregnant individuals may have chronically higher baseline IAP (as high as 10 – 15 mm Hg) without any adverse sequelae.

4. Intra Abdominal Pressure Grading of IAH includes GRADE 1 : IAP of 12 to 15 mm Hg GRADE 2 : IAP of 16 to 20 mm Hg GRADE 3 : IAP of 21 to 25 mm Hg GRADE 4 : IAP > 25 mm Hg ACS is defined as a sustained IAP > 20 mm Hg (with or without APP < 60 mm Hg) that is associated with new organ dysfunction. APP = MAP - IAP A target APP of at least 60 mm Hg is correlated with improved survival from IAH and ACS.

5. Etiology of ACS Hemoperitoneum Abdominopelvic trauma Retroperitoneal Hemorrhage Bowel distension Massive ascites Liver transplantation Pancreatitis P R I M A R Y

6. Etiology of ACS Aggressive fluid resuscitation (sepsis, burns, shock patients, pancreatitis etc ) S E C O N D A R y

7. Pathophysiology of ACS TRAUMA

8. Pathophysiology of ACS ACUTE PANCREATITIS Severity of disease associated with development of ACS. Current recommendation for fluid resuscitation in acute pancreatitis – 4 – 5 ml/kg/ hr for first 36 hours and not more than 48 hours.

9. Physiological Consequences

10. Diagnostic Evaluation of ACS INDIRET METHODS can be using intra gastric, intra colonic, intra vesical or IVC catheters. Measurement of bladder pressure is the standard method to screen for IAH and ACS. It is simple, minimally invasive and accurate.

11. Indications of IAP Monitoring Patient should be placed supine. Elevation of head end will result in higher IAP. Document the position and ensure all subsequent readings are taken in the same position. Adjust height of the transducer so that it is levelled at the cross section of mid axillary line and iliac crest.

12. Process for measuring of IAP

13. MANAGEMENT OF IAH/ACS

14. MANAGEMENT OF IAH/ACS

15. THANK YOU