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Abdominal Compartment Syndrome (ACS)

Definition

 It is defined as a sustained IAP over 20 mmHg and/or an abdominal perfusion pressure below 60
mmHg.

Types

 Primary abdominal compartment syndrome results from direct injury to the abdomen or pelvic
region.

 Secondary abdominal compartment syndrome doesn't originate from the abdominopelvic

region.

At Risk Populations

 Postoperative injured patient

 Medical patients that have undergone large volume fluid resuscitation

 General surgical patient

Risk Factors

 trauma

 burns

 liver transplantation

 abdominal conditions

 retroperitoneal conditions

 surgeries or illnesses

Pathophysiology

 The cardiac system is affected when IAPs are elevated because the external pressure exerted on
the inferior vena cava leads to diminished venous return and thus decreased cardiac output.

 The pulmonary system is affected largely because of pressure-induced cephalad displacement of

the hemidiaphragms and creating a functional restriction of diaphragmatic excursion and
pulmonary expansion.

 Patient’s exhibit decreased respiratory compliance, hypoxemia (relative or absolute), decreased

CO2 clearance, and distorted pulmonary flow characteristics.
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 Renal dysfunction manifesting as increased serum creatinine and oliguria is multifactorial.

Extrinsic renal vein compression, as well as increased venous impedance from IVC compression
cause decreased glomerular filtration, upregulation of antidiuretic hormone, and activation of
the rennin-angiotensin system stimulating water conservation.

 The decreased cardiac output secondary to diminished venous return may also lead to acute
tubular necrosis. One should note that rhabdomyolysis secondary to muscle crush injury may
also lead to renal failure.

 In addition, the central neuraxis, liver, and gastrointestinal tract similarly suffer hypoperfusion,
and when relieved, subsequent reperfusion injury manifested as visceral edema; the brain may
be somewhat more protected by virtue of the properties of an intact blood-brain barrier.

Assessment Findings

Physical assessment findings of abdominal compartment syndrome include:

 Tense

 Distended abdomen

 Progressive oliguria

 Increased ventilatory requirements

Other findings may include:

 hypotension

 tachycardia

 elevated jugular venous pressure

 jugular venous distension

 peripheral edema

 abdominal tenderness

 acute pulmonary decompensation

 evidence of hypoperfusion
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Laboratory/Diagnostic Tests

IAP Measurement-Intravesicular technique

 This method uses an indwelling urinary catheter, a pressure transducer, and a syringe or similar
device, capable of infusing fluid.

IAP Measurement- Via the inferior vena cava

 Using a closed system presents no discernable risk of urinary tract infection.

 A catheter is placed into the IVC through the right (easier) or left common femoral vein.

Treatment and Prognosis

 Treatment of abdominal compartment syndrome requires restoration of the perfusion gradient

across the abdomen, and broadly involves four approaches.

Four approaches:

 Removal of intraperitoneal collections and intraluminal bowel contents

 Addressing factors decreasing abdominal wall compliance

 Optimizing fluid status

 Surgical management with Operative Decompression

Operative Decompression

 This usually improves the organ changes and is followed by one of the temporary abdominal
closure techniques in order to prevent secondary intra-abdominal hypertension.

 Surgical decompression can be achieved by opening the abdominal wall and abdominal fascia
anterior in order to physically create more space for the abdominal viscera.

Bogota Bag

 A Bogota bag is a sterile plastic bag used for closure of abdominal wounds.

 It is generally a sterilized 3-liter genitourinary irrigation bag that is sewn to the skin or fascia of
the anterior abdominal wall.

Negative-pressure wound therapy

 A therapeutic technique using a suction pump, tubing and a dressing to remove

excess exudate and promote healing in acute or chronic wounds and second- and third-degree
burns.
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Nursing Interventions

 Monitor the patient's vital signs and surgical wound closely.

 Monitor patient for signs and symptoms of infection.

 Assess the patient each shift; more frequently if abnormalities occur.

 Assess the patient's pain using a valid and reliable pain intensity rating scale.

 Notify the physician, if the patient needs more analgesia than is prescribed.

 Perform a gastrointestinal assessment every shift or more frequently if needed, assessing for
abdominal distention, discoloration, and firmness.

 Assess bowel sounds.

 Assess the patient's nutritional status and ambulation status for changes from baseline.

 Monitor for signs and symptoms of infection.

 Monitor nutrition, ambulation, and bowel sounds.

 Monitor intake and output

 Provide emotional support for patients and families and monitor for psychological changes.

Complications

 Renal failure

 Ischemic bowel

 Respiratory failure

 Heart failure