Abdominal Compartment Syndrome Incidence and Mortality
Mortality Considerations
- The mortality associated with Abdominal Compartment Syndrome is catastrophic, ranging from 50% to nearly 100% depending on the urgency and success of rescue interventions, according to the World Journal of Emergency Surgery 1
Risk Factor Prevalence
- Diminished abdominal wall compliance, due to major trauma, major burns, abdominal surgery, or prone positioning, is a major risk factor for Abdominal Compartment Syndrome, as noted by the Intensive Care Medicine journal 2
- Increased intra-abdominal contents, such as acute pancreatitis, hemoperitoneum, intra-abdominal infection/abscess, or ascites, can also contribute to Abdominal Compartment Syndrome 2
- Capillary leak/fluid resuscitation, resulting from massive fluid resuscitation, positive fluid balance, polytransfusion, or damage control laparotomy, is another significant risk factor for Abdominal Compartment Syndrome 2
- Other high-risk factors, including sepsis, increased APACHE-II or SOFA scores, hypothermia, and acidosis, can also increase the likelihood of developing Abdominal Compartment Syndrome 2
Clinical Context
- The World Society of the Abdominal Compartment Syndrome establishes graded severity levels to capture the spectrum of Abdominal Compartment Syndrome, from intra-abdominal hypertension to frank Abdominal Compartment Syndrome 2
Measurement and Detection Implications
- The World Society of the Abdominal Compartment Syndrome recommends measuring intra-abdominal pressure when any known risk factor for intra-abdominal hypertension or Abdominal Compartment Syndrome is present in critically ill or injured patients 3
Risk‑Factor–Based Screening for Intra‑Abdominal Hypertension
Risk Factor Categories (World Society of the Abdominal Compartment Syndrome)
- The WSACS defines four major categories of risk factors that should trigger intra‑abdominal pressure (IAP) monitoring, including capillary leak, increased intravascular volume, diminished abdominal wall compliance, and increased intra‑abdominal contents. 4
- Tight abdominal dressings and eschars limit abdominal wall expansion, thereby reducing compliance and increasing IAH risk. 5
Screening Algorithm (World Society of the Abdominal Compartment Syndrome)
- Nurses should screen any critically ill patient who exhibits increased intravascular volume and capillary‑leak states, because these are the principal drivers of fluid accumulation and elevated IAP. 4
- When a patient presents with risk factors from at least two different WSACS categories, IAP should be measured every 4–6 hours. 4
- Patients meeting the ≥2‑category criterion have a markedly higher mortality (≈ 41 % vs ≈ 14 %) compared with those without such a combination of risk factors. 4
High‑Risk Clinical Scenarios (World Society of the Abdominal Compartment Syndrome)
- Immediate IAP screening is indicated for patients with major trauma who require ongoing transfusion support. 5