Intra-abdominal hypertension and abdominal compartment syndrome in critical illness

Increased intra-abdominal pressure occurs regularly in critically ill patients. The abdominal compartment syndrome occurs if pressure increases in combination with organ failure. When the abdominal compartment syndrome occurs, there is an increased risk of complications and death.In this thesis we investigated the occurrence of increased intra-abdominal pressure and abdominal compartment syndrome in critically ill patients. We compared the outcome between patients with normal intra-abdominal pressure and increased intra-abdominal pressure. Length of stay in the intensive care increased by a factor 9 in abdominal compartment syndrome. Mortality was higher in patients with increased intra-abdominal pressure compared to patients with normal intra-abdominal pressure. We found that abdominal compartment syndrome frequently occurs in patients with acute pancreatitis and that ischemia of intra-abdominal organs may occur. We investigated whether biomarkers of intestinal and kidney injury are related to intra-abdominal pressure. There were signs of inflammation and kidney injury in mild intra-abdominal pressure increase.An important message is that clinicians and ICU nursus should have a high index of suspicion for complications related to intra-abdominal pressure and a low threshold for measuring intra-abdominal pressure in critically ill patients, so that appropriate treatments may be implemented promptly. One major future challenge is to investigate whether treatment of increased intra-abdominal pressure prevents the abdominal compartment syndrome and improves patient outcome.

Dissertation: http://hdl.handle.net/11370/07a3f558-3dce-49e7-bfb3-43f25a46442f