Intra-abdominal hypertension and the abdominal compartment syndrome

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Abstract
Background: Abdominal compartment syndrome (ACS) occurs when intra‐abdominal pressure is abnormally high in association with organ dysfunction. It tends to have a poor outcome, even when treated promptly by abdominal decompression. Methods: A search of the Medline database was performed to identify articles related to intra‐abdominal hypertension and ACS. Results: Currently there is no agreed definition or management of ACS. However, it is suggested that intra‐abdominal pressure should be measured in patients at risk, with values above 20 mmHg being considered abnormal in most. Abdominal decompression should be considered in patients with rising pressure and organ dysfunction, indicated by increased airway pressure, reduced cardiac output and oliguria. Organ dysfunction often occurs at an intra‐abdominal pressure greater than 35 mmHg and may start to develop between 26 and 35 mmHg. The mean survival rate of patients affected by compartment syndrome is 53 per cent. Conclusion: The optimal time for intervention is not known, but outcome is often poor, even after decompression. Most of the available information relates to victims of trauma rather than general surgical patients. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.