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Abdominal Compartment Syndrome 2.e1

Abdominal Compartment Syndrome
VetBooks.ir Diseases and Disorders

HISTORY, CHIEF COMPLAINT
BASIC INFORMATION
• History of recent abdominal surgery or DIAGNOSIS
Definition trauma Diagnostic Overview
Sustained increase in intra-abdominal pressure • Abdominal distention of recent onset Measurement of IAP is required to diagnose
(IAP > 20 mm Hg) associated with multiple ACS. Serum biochemistry analysis may indicate
organ dysfunction or failure PHYSICAL EXAM FINDINGS early organ dysfunction.
• Abdominal distention and pain
Synonyms • Development or progression of organ failure Differential Diagnosis
Abdominal compartment syndrome (ACS), ○ Respiratory distress due to acute lung injury • Acute abdominal disease (peritonitis,
intra-abdominal hypertension (IAH) ○ Altered mentation, seizures due to pancreatitis)
increased intracranial pressure • Organ failure may be organic or a conse-
Epidemiology • Jugular venous distention quence of systemic inflammatory response
SPECIES, AGE, SEX • Tachypnea, tachycardia, weak pulses syndrome (SIRS).
Any dog or cat • Vomiting, diarrhea
• Organomegaly or hyperresonant viscus on Initial Database
RISK FACTORS abdominal palpation IAP measurement is most commonly performed
Increased intra-abdominal contents (fluid, gas, using a urinary catheter to measure intrave-
or tissue within the peritoneal cavity or Etiology and Pathophysiology sicular pressure (IVP).
abdominal organs), decreased abdominal wall • IAP is the pressure within the abdominal • A urethral catheter is placed using aseptic
compliance, and capillary leak increase risk of cavity. technique. This may require mild sedation
ACS ○ Normal IAP in dogs = 0-5.1 mm Hg depending on patient status.
• Recent abdominal trauma or surgery (most (0-7 cm H 2 O) ○ Urinary catheter fenestrations should be
common) ■ Normal IAP in healthy dogs after just inside the trigone of the bladder. Use
• Peritoneal effusion ovariohysterectomy = 0-15 cm H 2 O of a Foley catheter may help ensure
• Abdominal masses (neoplasia, hematoma, ○ Normal IAP in cats = 0-7.7 mm Hg appropriate catheter placement.
abscess) (4-8 cm H 2 O) in sedated cats; 0-13.7 mm • The urinary catheter is attached to sterile
• Restrictive abdominal wrap Hg (6-11 cm H 2 O) in awake cats extension tubing, which attaches to a 3-way
• Pain ○ IAP can vary with body positioning and stopcock.
• Obesity condition, pregnancy, pain, anxiety, and • A rigid water manometer is connected to
• Oliguria phase of respiration (higher during inspira- the upright port of the 3-way stopcock.
• Ileus tion; lower during expiration). • The distal port of the 3-way stopcock is
• Pancreatitis • IAH is sustained elevation of IAP ≥ 12 mm attached to sterile extension tubing and a
• Peritonitis Hg. The severity of IAH is based on the IAP, 60-mL syringe or sterile bag of 0.9% NaCl.
• Positive fluid balance; high-volume fluid with increasing grade indicating increasing ○ This is used to fill the manometer and to
resuscitation severity. allow infusion of sterile fluid into the
• Major burn injury ○ Grade I = IAP 12-15 mm Hg urinary bladder.
• High-pressure mechanical ventilation ○ Grade II = IAP 16-20 mm Hg • Empty the urinary bladder completely.
• Sepsis ○ Grade III = IAP 21-25 mm Hg • Infuse 0.5-1 mL/kg (or up to 25 mL) of
• Vasculitis ○ Grade IV = IAP > 25 mm Hg sterile 0.9% NaCl into the urinary bladder.
• ACS is sustained IAP > 20 mm Hg associated ○ Optimal volume for infusion into the
ASSOCIATED DISORDERS with new or progressive organ dysfunction bladder has not been determined for dogs
Rapid accumulation of peritoneal effusion, or failure. and cats.
multiple organ dysfunction, postsurgical • Increasing IAP leads to adverse effects on the ○ Infusing the same volume of saline each
complication cardiovascular system, decreased perfusion to time IAP is measured is recommended
organs, and subsequent organ dysfunction. when comparing IAP over time in the
Clinical Presentation ○ Cardiovascular: decreased cardiac output, same patient.
DISEASE FORMS/SUBTYPES decreased venous return from caudal half • Zero the system by positioning the manom-
• Primary ACS: disease in the abdomen, of the body, increased systemic vascular eter on midline at the level of the patient’s
typically in postoperative patients, or due resistance, increased central venous pres- pubic symphysis.
to abdominal trauma sure, increased mean arterial pressure • Fill the manometer with saline.
• Secondary ACS: disease outside of the ○ Central nervous system: increased intra- • Open the stopcock to the urinary bladder
abdomen requiring high-volume fluid cranial pressure, decreased cerebral perfu- (closed to the fluid infusion source).
resuscitation or high-pressure mechanical sion pressure • The meniscus of fluid in the manometer will
ventilation ○ Pulmonary: acute lung injury, impaired drop and reach equilibrium with the IVP.
• Recurrent ACS: IAH develops after a patient ventilation, hypoxemia • The difference between the zero point and
has been treated for primary or secondary ○ Renal: decreased urine output, azotemia the meniscus is the IAP, measured in cm of
ACS. ○ Liver: decreased hepatic and portal blood H 2O.
• Polycompartment syndrome: two or more flow, cholestasis and hepatic dysfunction • Commercial pressure transducers can be used
compartments in the body have elevated ○ Gastrointestinal: ileus, decreased intestinal to measure IAP from the urinary catheter
compartmental pressures. blood flow, bacterial translocation and can measure pressure in mm Hg or cm
• Transient IAH can occur in patients undergo- ○ Activation of renin-angiotensin-aldosterone H 2O.
ing laparoscopy with excessive inflation system (RAAS) • Abdominal perfusion pressure (APP) = mean
pressure. ○ Catecholamine release arterial pressure (MAP) − IAP

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