RESEARCH – April 2009

Abdominal compartment syndrome: incidence, diagnosis, treatment methods and outcome in the General Intensive Care Unit of Tartu University Hospital in 2004–2006


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AIM: To study the incidence, routine treatment practices and outcome of abdominal compartment syndrome (ACS) in the General ICU of Tartu University Hospital in 2004–2006.

METHODS: Retrospective analysis of prospectively stored data and patients’ charts. In 2004–2006 mechanically ventilated patients having at least one additional risk factor for intraabdominal hypertension (IAH) were included in the study. Intraabdominal pressure (IAP) was measured via the bladder, using the closed loop system repeated measurement technique. Measurements were performed at least twice daily, in patients with elevated IAP at least four times a day.

RESULTS: Of the 1075 patients admitted to the ICU from January 1, 2004 to December 31, 2006 intraabdominal pressure was measured in 362. Fifteen patients developed ACS. The APACHE II score for the group was 17.5±7.6 (mean ± SD), and the SOFA score was 9.8±2.9 (mean ± SD). Mortality rate was 66.7%. Primary ACS (caused by disease in the abdomino-pelvic region) was  observed in 12 cases and secondary ACS was found in 3 cases. ACS was not documented as a diagnosis in any of the study patients. In four cases it was reported in the decursus. Despite this, all patients received at least one of the following conservative treatments: paracentesis, CVVHDF, laxatives, nasogastric aspiration, sedation, negative fl uid balance, relaxants, rectal gas tube, enema, painkillers. The most common methods of conservative treatment were passive nasogastric aspiration (in all 15 patients), laxatives (in 6 cases) and deeper sedation (in 7 cases). Two operations were performed specifically for the treatment of ACS: a decompressive laparotomy and a tension-free abdominal closure. Ten patients were operated at least once for their primary disease (ruptured aortal aneurysm, peritonitis, etc.). Seven patients underwent tension- free abdominal closure with mesh.

CONCLUSIONS: ACS is a rare syndrome among intensive care patients but it has high ICU mortality. Primary ACS is more frequent than secondary ACS. According to our study, the awareness of intraabdominal pressure, ACS and its treatment strategies was low.