Abdominal Compartment Syndrome (ACS) and Intra-Abdominal ...

Abdominal Compartment Syndrome (ACS) and Intra-Abdominal Hypertension (IAH): 

 • Definition: IAH = IAP >12. ACS = IAP > 20 AND clinical evidence of organ dysfunction (e.g. high airway pressures, decreased venous return, elevated CVP/PCWP, ↓UOP/AKI, elevated lactate, acidemia). IAP measured via bladder pressure.

 • Typically occurs after massive resuscitation in ICU patients with trauma, burns, s/p liver tx, severe ascites, pancreatitis, sepsis.

 • Tx: if IAP 12-20 w/o clinical instability:

    o Evacuate lumenal contents (NGT/rectal tube/enema)

    o Increase pain control/sedation (to level of paralysis if necessary)

    o Head of bed tilted up

    o LVP if ascites

    o Decrease tidal volume, permissive hypercapnia

    o Avoid over-resuscitation

 • True ACS (IAP >20, organ dysfunction despite medical management): surgical decompression provides definitive management

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MGH White Book Manual
Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf

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