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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