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Definition, Pathophysiology, and Pathobiology of Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome

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Compartment Syndrome

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

Abstract

Knowing and understanding the effects of intra-abdominal pressure (IAP) on anatomy and physiology are crucial to manage critical illness and injury. Raised IAP, known as intra-abdominal hypertension (IAH), appears common in critical illness/injury. The pathophysiological consequences of IAH are complex: nearly every organ system may be affected through contiguous physical (polycompartment phenomenon) or biomediator (humoral and lymphatically spread) effects. When IAH is sustained above 20 mmHg, and associated with new organ dysfunction, patients are diagnosed with abdominal compartment syndrome (ACS). Although preventative, medical, and minimally invasive therapies are available, overt ACS is an emergency often warranting use of an open abdomen to decompress the abdominal cavity.

In 2006, standardized definitions of IAH and ACS were proposed by the WSACS—The Abdominal Compartment Society. Practical working definitions and later evidence-based management guidelines were felt critical to address the complex pathophysiologic challenges induced by these conditions. A notably missing topic from these highly referenced guidelines, however, is discussion of the relationship between IAH and the human microbiome, recognizing that humans are superorganisms, living in symbiosis with their gut microbiota. The symbiotic relationship between a healthy host human and a healthy microbiota within that host is critical for health. Given increasing basic science evidence that even modest IAH for short periods of time profoundly affect gut mucosa permeability, the presence of a dysbiome within a leaky gastrointestinal lining requires urgent study. Thus, the upcoming revisions of the Abdominal Compartment Society Consensus Guidelines will feature efforts to recognize the importance of new concepts regarding the human microbiome in critical illness, but remain grounded in established science.

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Acknowledgment

This Chapter is an updated and revised version of the chapter “Intra-abdominal hypertension, Abdominal Compartment Syndrome, and the Open Abdomen: Looking Beyond the Obvious to New Understandings in Pathophysiology, Harm Reduction, and Systemic Therapies”. Kirkpatrick AW, Roberts DJ, Coccolini F. In: E Picetti, Peireira BM, T Razek, M Narayan, JL Kashuk F (Eds). Intensive Care for Emergency Surgeons. Springer, Cham Switzerland, 2019 pps 237–262.

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Authors and Affiliations

  1. Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada

    Andrew W. Kirkpatrick

  2. Critical Care Medicine, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada

    Andrew W. Kirkpatrick

  3. Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada

    Andrew W. Kirkpatrick

  4. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  5. Department of Critical Care Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada

    Braedon McDonald

  6. The Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Derek J. Roberts

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  1. Andrew W. Kirkpatrick
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  2. Federico Coccolini
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  3. Braedon McDonald
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  4. Derek J. Roberts
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Corresponding author

Correspondence to Andrew W. Kirkpatrick .

Editor information

Editors and Affiliations

  1. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. Intensive Care Unit, Ziekenhuisnetwerk Antwerpen Stuivenberg, Antwerpen, Belgium

    Manu L.N.G. Malbrain

  3. Regional Trauma Services, Foothills Medical Centre, Calgary, AB, Canada

    Andrew W Kirkpatrick

  4. Chief Physician in Intensive Care Unit and Trauma Management in Level-1 Trauma Center, “M. Bufalini” Hospital, CESENA, Forli/Cesana, Italy

    Emiliano Gamberini

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Kirkpatrick, A.W., Coccolini, F., McDonald, B., Roberts, D.J. (2021). Definition, Pathophysiology, and Pathobiology of Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome. In: Coccolini, F., Malbrain, M.L., Kirkpatrick, A.W., Gamberini, E. (eds) Compartment Syndrome. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-55378-4_6

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