Abdominal compartment syndrome (ACS) is a condition in which the internal pressure of the abdomen becomes so great that it compromises venous return (and therefore hypotension), organ perfusion, and adequate ventilation.
This condition is often present in patients with massive ascites, preop and postop surgical abdomens, intra and extraperitoneal hemorrhage, and burn victims. Patient will present with a rigid, distended abdomen and may have very elevated peak pressures on vent, persistent hypotension, and JVD. Abdominal pressures above 20 mmHg that is associated with new organ dysfunction meets criteria for ACS, although intraabdominal hypertension with pressure above 12 mmHg.
The easiest way to indirectly measure intraabdominal pressure in the ED is by measuring the bladder pressure. Commercial solutions are available, although the simplest way to perform this is by using a typical arterial line setup as shown below:
- Clamp the foley distal to the aspiration port.
- Instill 60cc’s sterile fluid into the aspiration port to ensure there is a continuous column of fluid through which pressure can transmit.
- Attach a primed pressure line to the aspiration port.
- Zero transducer at mid-axillary line (approximately where the bladder is).
- Measure bladder pressure as you would measure invasive arterial pressure at end expiration to ensure lack of external pressure.
Note: A pressure bag is not required to obtain this measurement.
Definitive management is to relieve the cause of the increased pressure which would usually involve opening the abdomen. With this information you can further tailor your patient’s resuscitation to their specific needs.
Gestring, M. Abdominal compartment syndrome. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on September 29, 2015.)