Multisystem organ failure secondary to increased intraabdominal pressure
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Acutely increased intraabdominal pressure can lead to multisystem organ dysfunction. Organ dysfunction consists of acute pulmonary failure secondary to compressive atelectasis and associated with high peak inspiratory pressures and impaired gas exchange, acute renal failure with marked oliguria without hypernaturia, intestinal and hepatic ischemia possibly leading to bacterial translocation or necrosis with peritonitis, increased intracranial pressures which may cause brain dysfunction or aggravate head injury edema, venous thrombosis and thromboembolism, and abdominal wall ischemia or necrosis. The diagnosis is made clinically in a patient with high peak inspiratory pressures, oliguria and an apparently tight abdomen, although urinary bladder pressure ≥ 20 cm H2O pressure is suggestive. However, chronically increased intraabdominal pressure as is seen in the morbidly pregnancy and cirrhosis may be misleading. As to treatment, once the diagnosis is made, the patient's abdomen should be opened and the tension relieved. The intestinal contents need to be protected and evaporative water loss minimized by either closing the skin and not the fascia or, if this is not possible, using an impermeable protective dressing. If the abdomen is difficult to close at the primary operation, it is best to prevent the development of an acute abdominal compartment syndrome by closing only the skin or leaving it open and using an impermeable dressing. In conclusion, the acute abdominal compartment syndrome has become increasingly recognized as a cause for multisystem organ failure. Recognition of the problem or prevention is mandatory for optimal patient survival.
- Harman, P. K., Kron, I. L., McLachlan, H. D., Freedlander, A. E., Nolan, S. P.: Elevated intra-abdominal pressure and renal function. Ann. Surg. 196 (1982) 594–597. CrossRef
- Richardson, J. D., Trinkle, J. K.: Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J. Surg. Res. 20 (1976) 401–404. CrossRef
- Fietsam, R. Jr., Villalba, M., Glover, J. L., Clark, K.: Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am. J. Surg. 55 (1989) 396–402.
- Platell, C. F., Hall, J., Clarke, G., Lawrence-Brown, M.: Intra-abdominal pressure and renal function after surgery to the abdominal aorta. Aust. N Z J. Surg. 60 (1990) 213–216.
- Richards, W. O., Scovill, W., Shin, B., Reed, W.: Acute renal failure associated with increased intra-abdominal pressure. Ann. Surg. 197 (1983) 183–187.
- Bloomfield, G. L., Blocher, C. R., Fakhry, I. F., Sica, D. A., Sugerman, H. J.: Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J. Trauma 42 (1997) 997–1005.
- Cullen, D. J., Coyle, J. P., Teplick, R., Long, M. C.: Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit. Care Med. 17 (1989) 118–121. CrossRef
- Mutoh, T., Lamm, J. E., Embree, L. J., Hildebrandt, J., Albert, R. K.: Abdominal distension alters regional pleural pressures and chest wall mechanics in pigsin vivo. J. Appl. Physiol. 70 (1991) 2611–2618.
- Smith, J. H., Merrell, R. C., Raffin, T. A.: Reversal of postoperative anuria by decompressive celiotomy. Arch. Intern. Med. 145 (1985) 553–554. CrossRef
- Diament, L., Benumof, J. L., Saidman, L. J.: Hemodynamics of increased intra-abdominal pressure. Anesthesiology 48 (1978) 23–26. CrossRef
- Kashtan, J., Green, J. F., Parsons, E. Q., Holcroft, J. W.: Hemodynamic effects of increased abdominal pressure. J. Surg. Res. 30 (1981) 249–255. CrossRef
- Ridings, P. C., Bloomfield, G. L., Blocher, C. R., Sugerman, H. J.: Cardiopulmonary effects of raised intra-abdominal pressure before and after volume expansion. J. Trauma 39 (1995) 1071–1075.
- Shelley, M. P., Robinson, A. A., Hesforf, J. W.: Hemodynamic effects following surgical release of increased intra-abdominal pressure. J. Surg. Res. 59 (1981) 800–805.
- Meldrum, D. R., Moore, F. A., Moore, E. E., Haenel, J. B., Cosgriff, N., Burch, J. M.: Cardiopulmonary hazards of perihepatic packing for major liver injuries. Am. J. Surg. 170 (1995) 537–540. CrossRef
- Bloomfield, G. L., Ridings, P. C., Blocher, C. S., Marmarou, A., Sugerman, H. J.: Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J. Trauma 40 (1996) 936–943. CrossRef
- Mijangos, J. L., Thwin, N., Hinchey, E. J.: Changes in intracranial pressure during carbon dioxide pneumoperitoneum in normovolemic and hypovolemic animals. Surg. Forum 45 (1994) 583–586.
- Bloomfield, G. L., Ridings, P. C., Blocher, C. R., Marmarou, A., Sugerman, H. J.: A proposed relationship between increased intra-abdominal pressure, intrathoracic, and intracranial pressure. Crit. Care Med. 25 (1997) 496–503. CrossRef
- Josephs, L. G., Este-McDonald, J. R., Birkett, D. H., Hirsch, E. F.: Diagnostic laparoscopy increases intracranial pressure. J. Trauma 36 (1994) 815–819.
- Irgau, I., Koyfman, Y., Tikellis, J. I.: Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy. Arch. Surg. 130 (1995) 1101–1103.
- Bloomfield, G. L., Dalton, J. M., Sugerman, H. J., Ridings, P. C., DeMaria, E. J., Bullock, R.: Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J. Trauma 30 (1995) 1168–1170.
- Diebel, L. N., Wilson, R. F., Dulchavsky, S. A., Saxe, J.: Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J. Trauma 33 (1992) 279–282.
- Diebel, L. N., Dulchavsky, S. A., Wilson, R. F.: Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal blood flow. J. Trauma 33 (1992) 45–49.
- Diebel, L., Saxe, J., Dulchavsky, S.: Effect of intra-abdominal pressure on abdominal wall blood flow. Ann. Surg. 58 (1992) 573–575.
- Iberti, T. J., Kelly, K. M., Gentili, D. R., Hirsch, S., Benjamin, E.: A simple technique to accurately determine intra-abdominal pressure. Crit. Care Med. 15 (1987) 1140–1142.
- Lacey, S. R., Bruce, J., Brooks, S. P., Griswald, J., Ferguson, W., Allen, J. E., Jewett, T. C., Jr., Karp, M. P., Cooney, D. R.: The relative merits of various methods of indirect measurement of intra-abdominal pressure as a guide to closure of abdominal wall defects. J. Pediatr. Surg. 22 (1987) 1207–1211.
- Sugerman, H., Windsor, A., Bessos, M., Wolfe, L.: Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J. Int. Med. 241 (1997) 71–79. CrossRef
- Hirshberg, A., Wall, M. J. Jr., Mattox, K. L.: Planned reoperation for trauma: a two year experience with 124 consecutive patients. J. Trauma 37 (1994) 365–369.
- Wittmann, D. H., Aprahamian, C., Bergstein, J. M.: Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fasteners, and Velcro analogue for temporary abdominal closure. World J. Surg. 14 (1990) 218–226. CrossRef
- Wittmann, D. H., Aprahamian, C., Bergstein, J. M., Edmiston, C. E., Frantzides, C. T., Quebbeman, E. J., Condon, R. E.: A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur. J. Surg. 159 (1993) 75–79.
- Rotondo, M. F., Schwab, C. W., McGonigal, M. D., Phillips, G. R. 3d, Fruchterman, T. M., Kauder, D. R., Latenser, B. A., Angood, P. A.: “Damage Control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J. Trauma 35 (1993) 375–382. CrossRef
- Schein, M., Wittman, D. H., Aprahamian, C. C., Condon, R. E.: The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J. Am. Coll. Surg. 180 (1995) 745–753.
- Fabian, T. C., Croce, M. A., Pritchard, F. E., Minard, G., Hickerson, W. L., Howell, R. L., Schurr, M. J., Kudsk, K. A.: Planned ventral hernia. Staged management for acute abdominal wall defects. Ann. Surg. 219 (1994) 643–650. CrossRef
- Morris, J. A. Jr., Eddy, V. A., Blinman, T. A., Rutherford, E. J., Sharp, K. W.: The staged celiotomy for trauma. Issues in unpacking and reconstruction. Ann. Surg. 217 (1993) 576–584. CrossRef
- Multisystem organ failure secondary to increased intraabdominal pressure
Volume 27, Issue 1 , pp 61-66
- Cover Date
- Print ISSN
- Online ISSN
- Urban & Vogel
- Additional Links
- Industry Sectors