ICU · GI & nutrition / surgical

Intra-abdominal Hypertension & Abdominal Compartment Syndrome — IAP, APP & Decompression

Also known as Intra-abdominal hypertension · IAH · Abdominal compartment syndrome · ACS · Intra-abdominal pressure · IAP · Abdominal perfusion pressure · APP · WSACS · Bladder pressure · Decompressive laparotomy · Open abdomen

The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are the raised intra-abdominal pressure (IAP) and its consequences. The WSACS definitions: the IAP is measured via the bladder with the patient supine, instilling no more than 25 mL of saline; a normal IAP is about 5 to 7 mmHg; the IAH is a sustained IAP of 12 mmHg or more (graded I to IV); the abdominal perfusion pressure (APP) equals the MAP minus the IAP, with a mean APP under 60 mmHg marking abdominal hypoperfusion; the ACS is a sustained IAP over 20 mmHg PLUS new organ dysfunction or failure. The organ effects: reduced venous return and cardiac output with falsely high CVP, raised airway pressure, renal failure, splanchnic ischaemia, raised ICP. The primary ACS (the abdominopelvic cause) vs the secondary (the sepsis, the massive fluid resuscitation, the burns). IAH is medical; ACS is surgical — decompressive laparotomy.