Ana P C P Carlotti1, Werther B Carvalho. 1. Department of Pediatrics (APCPC), Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil. carlotti@fmrp.usp.br
Abstract
OBJECTIVES: The aims of this review were to summarize a) the consensus definitions of normal and pathologic intra-abdominal pressure (IAP); b) the techniques to measure IAP; c) the risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); d) the pathophysiology of ACS; and e) the current recommendations for management and prevention of ACS. DATA SOURCES: PubMed was searched using the following terms: ACS, IAH, IAP, and abdominal decompression. DATA SYNTHESIS: ACS represents the natural progression of end-organ dysfunction caused by increased IAP and develops if IAH is not recognized and treated appropriately. Although the reported incidence of ACS is relatively low in critically ill children (0.6%-4.7%) it may be under-recognized and under-reported. The diagnosis of IAH/ACS depends on a high index of suspicion and the accurate and frequent measurement of IAP in patients at risk. Mortality from ACS remains high (50%-60%) even when decompression of the abdomen is performed early, which highlights the importance of detection and treatment of elevated IAP before end-organ damage occurs. CONCLUSIONS: A widespread awareness of the recognition and current approach to management and prevention of IAH and ACS is needed among pediatric intensivists, so outcome of these life-threatening disease processes might be improved.
OBJECTIVES: The aims of this review were to summarize a) the consensus definitions of normal and pathologic intra-abdominal pressure (IAP); b) the techniques to measure IAP; c) the risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); d) the pathophysiology of ACS; and e) the current recommendations for management and prevention of ACS. DATA SOURCES: PubMed was searched using the following terms: ACS, IAH, IAP, and abdominal decompression. DATA SYNTHESIS: ACS represents the natural progression of end-organ dysfunction caused by increased IAP and develops if IAH is not recognized and treated appropriately. Although the reported incidence of ACS is relatively low in critically ill children (0.6%-4.7%) it may be under-recognized and under-reported. The diagnosis of IAH/ACS depends on a high index of suspicion and the accurate and frequent measurement of IAP in patients at risk. Mortality from ACS remains high (50%-60%) even when decompression of the abdomen is performed early, which highlights the importance of detection and treatment of elevated IAP before end-organ damage occurs. CONCLUSIONS: A widespread awareness of the recognition and current approach to management and prevention of IAH and ACS is needed among pediatric intensivists, so outcome of these life-threatening disease processes might be improved.
Authors: Keliana O'Mara; Peter Gal; John Wimmer; J Laurence Ransom; Rita Q Carlos; Mary Ann V T Dimaguila; Christie C Davanzo; McCrae Smith Journal: J Pediatr Pharmacol Ther Date: 2012-07