Friday, February 24, 2006

Intraabdominal compartment syndrome

Friday February 24, 2006
Grading of Intra-abdominal Hypertension (intra-abdominal compartment syndrome)

Burch and co. defined a grading system of IAH :

Grade I (10-15 cmH2O),
grade II (15-25 cmH2O),
grade III (25-35 cmH2O) and
grade IV (>35 cmH2O).

With massive fluid resuscitation as part of critical care management, intensivists need to be constantly cautious of this complication. End-organ damage has been described with bladder pressure as low as 10 cm H2O. Intra-abdominal Hypertension is defined as sustained or repeated pressure more than/= 12 and Intra-abdominal compartment syndrome as sustained or repeated pressure more than/= 20.

Although bladder pressure is not the accurate method of diagnosing IAH but so far has been used as standard due to its bedside ease. Dr. Cheatham has proposed APP (Abdominal Perfusion Pressure) as better indicator with formula

APP = MAP- IAP (like CPP = MAP - ICP).
where MAP is mean arterial pressure and IAP is intra-abdominal pressure.

Intra-abdominal Hypertension is defined as sustained or repeated APP less than or = 60

See good review here with details of how to measure bladder pressure to diagnose Intra-abdominal Hypertension from (Dr. MALBRAIN - Hôpital Sainte Elisabeth, Bruxelles, Belgium).

Another review article
here from (Dr. Paula Richard).

Referencss: Click to get abstract /article
The abdominal compartment syndrome. - Burch JM, Moore EE, Moore FA, Franciose R Surg Clin North Am. 1996 Aug;76(4):833-42.
Abdominal Perfusion Pressure: A Superior Parameter in the Assessment of Intra-abdominal Hypertension Journal of Trauma-Injury Infection & Critical Care. 49(4):621-627, October 2000.