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Abdominelles Kompartmentsyndrom

Bedeutung, Diagnostik und Therapie

Abdominal compartment syndrome

Significance, diagnosis and treatment

Der Anaesthesist volume 55, pages 660–667 (2006)Cite this article

Zusammenfassung

Ein pathologischer Anstieg des intraabdominellen Drucks (IAD) ist bei kritisch kranken Patienten mit chirurgischer Grunderkrankung häufig. In der Folge kann es zur Ausbildung eines abdominellen Kompartmentsyndroms (AKS) kommen, das durch einen IAD >20 mmHg (>2,67 kPa) bei gleichzeitigem Ausfall eines oder mehrer Organe charakterisiert ist. Die Letalität dieser Komplikation beträgt >60%. Das Wissen um die deletären Folgen eines AKS ist verbreitet, dennoch wird auch bei Risikopatienten keine routinemäßige Messung des IAD durchgeführt. Ursächlich dafür könnten die variable Inzidenz des AKS und Skepsis hinsichtlich der Messdurchführung und der Messergebnisse sein. Mittlerweile kann die IAD-Messung semiautomatisch, kontinuierlich und standardisiert erfolgen. Die Therapie des AKS – bestehend aus dekompressiver Laparotomie und Anlage eines Laparostomas – ist unumstritten. Da eine heterogene Patientengruppe davon betroffen sein kann, ist eine IAD-Überwachung bei allen intensivpflichtigen Patienten zu empfehlen. Eine konsequente IAD-Erfassung würde zu einer nachhaltigen Verbesserung der Datenlage führen und damit die Empfehlungen zur Therapie des pathologisch erhöhten IAD auf eine valide Grundlage stellen. Dennoch muss beim Verdacht auf ein AKS umgehend eine Dekompression durchgeführt werden.

Abstract

A pathological increase of intraabdominal pressure (IAP) is frequently observed in severely ill patients suffering from surgical diseases. This may lead to the abdominal compartment syndrome (ACS) which is characterized by an IAP >20 mmHg (>2.67 kPa) and failure of one or more organ systems. The mortality of ACS exceeds 60%. Knowledge concerning the sequelae of ACS is abundant, however, measurement of IAP is not routinely performed even if patients present with corresponding risk factors. This is probably due to a variable incidence of ACS and scepticism regarding the results of bladder pressure measurement. However, measurement of IAP can now be performed semi-automatically, continuously and in a standardized fashion. The therapy of ACS, i.e. decompression laparotomy and laparostomy, is undisputed. Since a heterogeneous group of patients can be affected, monitoring of IAP is indicated in patients needing intensive care. A consistent registration of IAP will improve knowledge and guidelines regarding the therapy of a pathologically increased IAP. Nevertheless, patients in whom ACS is suspected should be decompressed as soon as possible.

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Affiliations

  1. Klinik für Allgemein-, Gefäß- und Viszeral-Chirurgie, Marienhospital, Rochusstr. 2, 40479, Düsseldorf

    A. Schachtrupp

  2. Chirurgische Universitätsklinik und Poliklinik, RWTH, Aachen

    A. Schachtrupp, M. Jansen, P. Bertram & V. Schumpelick

  3. Klinik für Operative Intensivmedizin, RWTH, Aachen

    R. Kuhlen

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  1. A. Schachtrupp
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  2. M. Jansen
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  3. P. Bertram
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  4. R. Kuhlen
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Schachtrupp, A., Jansen, M., Bertram, P. et al. Abdominelles Kompartmentsyndrom. Anaesthesist 55, 660–667 (2006). https://doi.org/10.1007/s00101-006-1019-2

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Schlüsselwörter

  • Abdominelles Kompartmentsyndrom
  • Intraabdomineller Druck
  • Intraabdominelle Hypertension
  • Blasendruckmessung
  • Laparostoma

Keywords

  • Abdominal compartment syndrome
  • Intra-abdominal pressure
  • Intra-abdominal hypertension
  • Bladder pressure
  • Laparostomy