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Abdominal Compartment Syndrome in Children

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Pediatric Critical Care Medicine

Abstract

Abdominal compartment syndrome (ACS) is a clinical syndrome resulting from increased intra-abdominal pressure (IAP) and characterized by progressive end-organ dysfunction and failure, affecting mainly the hemodynamic, respiratory, renal and gastrointestinal systems. If untreated, ACS can deteriorate rapidly to critical organ failure and death. On the other hand, rapid relief of the elevated IAP often reverses the adverse pathophysiologic changes promptly.

Consensus definitions of intra-abdominal hypertension (IAH) and ACS have been published for adult patients, but similar definitions for children are lacking (See Appendix). For adults, ACS is defined as sustained increase of IAP >20 mmHg associated with new organ dysfunction or organ failure. ACS may be primary – resulting from an intra-abdominal cause (abdominal trauma, post abdominal surgery, ascites etc.) or secondary – caused by extra-abdominal causes, typically in conditions requiring massive fluid resuscitation. The reported incidence of ACS among critically ill children is relatively low compared to adults, though it may be under-recognized.

The diagnosis of ACS requires a high index of suspicion, and a comprehensive management approach consists of IAP monitoring, prevention, and medical and surgical measures. IAP monitoring can be easily and reliably achieved through measurement of the urinary bladder pressure using simple bedside techniques. Prevention consists of prophylactic use of incomplete, temporary abdominal closure following surgery and avoidance of excessive fluid resuscitation. Medical management includes measures to reverse fluid overload, improve abdominal wall compliance and the non-operative evacuation of excessive intra-abdominal contents. Once these measures fail to relieve IAH and ACS, decompressive laparotomy (DL) is crucial and should not be delayed.

DL often results in dramatic stabilization of the patient’s condition. However, the overall outcome of pediatric patients who have developed ACS and required DL remains poor, with reported 40–60 % mortality rates.

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Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Meyer Children’s Hospital, Rambam Medical Center, Bat Galim, 9602, Haifa, 31096, Israel

    Ori Attias MD

  2. Department of Pediatric Intensive Care, Meyer Children’s Hospital, Rambam Medical Center, Bat Galim, Haifa, 31096, Israel

    Gad Bar-Joseph MD

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  1. Ori Attias MD
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  2. Gad Bar-Joseph MD
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Correspondence to Gad Bar-Joseph MD .

Editor information

Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

Appendix

Appendix

Following completion of this Chapter, updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome were published in July 2013 [153, 154].

The Pediatric Sub-Committee of the WSACS reviewed the (adult) main management guidelines in regard to their applicability and suitability for children, but could not make firm recommendations and proposed pediatric specific definitions:

  1. 1.

    ACS in children is defined as a sustained elevation in IAP of greater than 10 mmHg associated with new or worsening organ dysfunction that can be attributed to elevated IAP.

  2. 2.

    The reference standard for intermittent IAP measurement in children is via the bladder using 1 mL/kg as an instillation volume, with a minimal instillation volume of 3 mL and a maximum installation volume of 25 mL of sterile saline.

  3. 3.

    IAP in critically ill children is approximately 4–10 mmHg.

  4. 4.

    IAH in children is defined by a sustained or repeated pathological elevation in IAP >10 mmHg.

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Attias, O., Bar-Joseph, G. (2014). Abdominal Compartment Syndrome in Children. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_4

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