Document Detail

Abdominal compartment syndrome in the surgical intensive care unit.
MedLine Citation:
PMID:  12467311     Owner:  NLM     Status:  MEDLINE    
The abdominal compartment syndrome (ACS) is a clinical entity that develops after sustained and uncontrolled intra-abdominal hypertension. ACS has been demonstrated to affect multiple organ systems including the cardiovascular, respiratory, gastrointestinal, genitourinary, and neurologic systems. To date most descriptions of ACS are found in the trauma literature, but the development of ACS in the general surgical population is being increasingly observed. In this study the development of ACS in a nontrauma surgical population is described and examined. The records of 18 surgical intensive care unit patients with documented ACS were reviewed retrospectively. Data acquired included demographics, urine output in mL/hour, cardiac index in L/m2/min: systemic vascular resistance index in mm Hg/L/m2/min: and pulmonary artery occlusion pressure, peak inspiratory pressure, partial pressure of oxygen in arterial blood, pH, partial pressure of carbon dioxide, and intra-abdominal pressure (all in mm Hg). When they were available values were obtained before and after decompression. Data are presented as mean +/- standard deviation and are analyzed by Student's t-test; significance was accepted to correspond to a P value <0.05. Nineteen episodes of ACS were identified in 18 patients. The average age was 69.2 years, and the observed mortality of the group was 61.1 per cent (11 of 18). Diagnoses included abdominal aortic aneurysm (eight), postoperative laparotomy (six), pancreatitis (three), and cerebral aneurysm (one). Of the parameters examined urine output, peak inspiratory pressure, and cardiac index demonstrated a significant change before and after decompression. The average intra-abdominal pressure was 43.4 mm Hg. Five of 18 patients (two with abdominal aortic aneurysm, two with postoperative laparotomy, and one with pancreatitis) were found to have necrotic bowel on decompressive laparotomy. The development of ACS is described in a surgical intensive care unit. ACS is the end result of uncontrolled intra-abdominal hypertension and results in systemic derangements. Surgical decompression of ACS significantly reduces peak inspiratory pressure while increasing urine output and cardiac index. The observed association between ACS and ischemic bowel may result from decreased mucosal perfusion as a direct result of abdominal hypertension. In our patient population ACS resulted in a 61.1 per cent mortality.
John Mcnelis; Samuel Soffer; Corrado P Marini; Antoni Jurkiewicz; Garry Ritter; H Hank Simms; Ira Nathan
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  68     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-12-06     Completed Date:  2003-01-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-23     Citation Subset:  IM    
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
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MeSH Terms
Compartment Syndromes / diagnosis,  mortality,  physiopathology,  surgery*
Decompression, Surgical*
Intensive Care Units
Middle Aged
Multiple Organ Failure / etiology,  physiopathology
Postoperative Complications* / diagnosis,  mortality,  physiopathology
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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