Critical care

1. Abdominal Compartment Syndrome M.A.Elmoneim IABFH-ICU

14. Pathophysiology IAH and ACS have numerous implications on end-organ function within and far outside the abdominal cavity ORGAN FAILURE Progressive Cellular Injury Cellular Death Metabolic Acidosis Anaerobic Metabolism Inadequate O2 delivery Edema

16. Pulmonary Reduction in minute ventilation Lung compression Pathophysiology IAP Elevation Of diaphragm Intrathoracic Pressure Tidal Volume Atelectasis Hypoxia Hypercarbia Cardiac manifestations

17. Gastointestinal Animal studies have demonstrated profound reductions in mesenteric and hepatic blood flow occurring with ACS The mucosa seems to be the most sensitive to these reductions Pathophysiology Gut Perfusion mucosal hypoxia and acidosis Ischemia Necrosis bacterial translocation SIRS IAP

18. Renal Pathophysiology IAP Renal Veins & Arteries Compression Renal Perfusion GFR Urine output Renal Failure + CO If untreated

19. CNS Pathophysiology IAP Intrathoracic Pressure Sup. VC Preassure Drainage Of SVC CVP IJ Pressure ICP Cerebral Edema Brain Anoxia & Injury

22. Prevalence of intra-abdominal hypertension in critically ill patients Malbrain et al, Intensive Care Med 2004 Conclusion: This study suggests that IAP should be routinely measured Abdominal pressure Total Prevalence MICU prevalence SICU prevalence IAP > 12 58.8% 54.4% 65% IAP > 20 plus organ failure 8.2% 10.5% 5.0%

23. IAP as a Prognostic Factor IAP is an independent predictor of ICU morbidity and mortality Table: incidence of adverse outcome post major surgery Surgue, Arch Surg 1999 Mortality Abdominal Sepsis Oliguria Renal Impairment IAP 8% 5% 15% 15% Normal 45% 17% 38% 69% > 20

29. Treatment Decompressive laparotomy