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Abdominelles Kompartmentsyndrom

Bedeutung, Diagnostik und Therapie

Abdominal compartment syndrome

Significance, diagnosis and treatment

  • Intensivmedizin
  • Published:
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Zusammenfassung

Ein pathologischer Anstieg des intraabdominellen Drucks (IAD) ist bei kritisch kranken Patienten mit chirurgischer Grunderkrankung häufig. In der Folge kann es zur Ausbildung eines abdominellen Kompartmentsyndroms (AKS) kommen, das durch einen IAD >20 mmHg (>2,67 kPa) bei gleichzeitigem Ausfall eines oder mehrer Organe charakterisiert ist. Die Letalität dieser Komplikation beträgt >60%. Das Wissen um die deletären Folgen eines AKS ist verbreitet, dennoch wird auch bei Risikopatienten keine routinemäßige Messung des IAD durchgeführt. Ursächlich dafür könnten die variable Inzidenz des AKS und Skepsis hinsichtlich der Messdurchführung und der Messergebnisse sein. Mittlerweile kann die IAD-Messung semiautomatisch, kontinuierlich und standardisiert erfolgen. Die Therapie des AKS – bestehend aus dekompressiver Laparotomie und Anlage eines Laparostomas – ist unumstritten. Da eine heterogene Patientengruppe davon betroffen sein kann, ist eine IAD-Überwachung bei allen intensivpflichtigen Patienten zu empfehlen. Eine konsequente IAD-Erfassung würde zu einer nachhaltigen Verbesserung der Datenlage führen und damit die Empfehlungen zur Therapie des pathologisch erhöhten IAD auf eine valide Grundlage stellen. Dennoch muss beim Verdacht auf ein AKS umgehend eine Dekompression durchgeführt werden.

Abstract

A pathological increase of intraabdominal pressure (IAP) is frequently observed in severely ill patients suffering from surgical diseases. This may lead to the abdominal compartment syndrome (ACS) which is characterized by an IAP >20 mmHg (>2.67 kPa) and failure of one or more organ systems. The mortality of ACS exceeds 60%. Knowledge concerning the sequelae of ACS is abundant, however, measurement of IAP is not routinely performed even if patients present with corresponding risk factors. This is probably due to a variable incidence of ACS and scepticism regarding the results of bladder pressure measurement. However, measurement of IAP can now be performed semi-automatically, continuously and in a standardized fashion. The therapy of ACS, i.e. decompression laparotomy and laparostomy, is undisputed. Since a heterogeneous group of patients can be affected, monitoring of IAP is indicated in patients needing intensive care. A consistent registration of IAP will improve knowledge and guidelines regarding the therapy of a pathologically increased IAP. Nevertheless, patients in whom ACS is suspected should be decompressed as soon as possible.

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Literatur

  1. Balogh Z, McKinley BA, Cocanour CS et al. (2003) Patients with impending abdominal compartment syndrome do not respond to early volume loading. Am J Surg 186: 602–607

    Article  PubMed  Google Scholar 

  2. Balogh Z, McKinley BA, Cocanour CS et al. (2003) Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 138: 637–643

    Article  PubMed  Google Scholar 

  3. Balogh Z, McKinley BA, Holcomb JB et al. (2003) Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 54: 848–859

    PubMed  Google Scholar 

  4. Balogh Z, Jones F, D’Amours S et al. (2004) Continuous intra-abdominal pressure measurement technique. Am J Surg 188: 679–684

    Article  PubMed  Google Scholar 

  5. Biffl WL, Moore EE, Burch JM et al. (2001) Secondary abdominal compartment syndrome is a highly lethal event. Am J Surg 182: 645–648

    Article  PubMed  Google Scholar 

  6. Blanch L, Villagra A (2004) Recruitment maneuvers might not always be appropriate in ARDS. Crit Care Med 32: 2540–2541

    Article  PubMed  Google Scholar 

  7. Bloomfield GL, Blocher CR, Fakhry IF et al. (1997) Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma 42: 997–1004

    Article  Google Scholar 

  8. Brooks AJ, Simpson A, Delbridge M et al. (2005) Validation of direct intraabdominal pressure measurement using a continuous indwelling compartment pressure monitor. J Trauma 58: 830–832

    PubMed  Google Scholar 

  9. Brower RG, Morris A, MacIntyre N et al. (2003) Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med 31: 2592–2597

    PubMed  Google Scholar 

  10. Brower RG, Lanken PN, MacIntyre N et al. (2004) Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351: 327–336

    Article  PubMed  Google Scholar 

  11. Chang MC, Miller PR, D’Agostino R Jr, Meredith JW (1998) Effects of abdominal decompression on cardiopulmonary function and visceral perfusion in patients with intra-abdominal hypertension. J Trauma 44: 440–445

    PubMed  Google Scholar 

  12. Cheatham ML, White MW, Sagraves SG et al. (2000) Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 49: 621–626

    PubMed  Google Scholar 

  13. Diebel L, Saxe J, Dulchavsky S (1992) Effect of intra-abdominal pressure on abdominal wall blood flow. Am Surg 58: 573–575

    PubMed  Google Scholar 

  14. Diebel LN, Wilson RF, Dulchavsky SA, Saxe J (1992) Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 33: 279–282

    PubMed  Google Scholar 

  15. Ertel W, Oberholzer A, Platz A et al. (2000) Incidence and clinical pattern of the abdominal compartment syndrome after „damage-control“ laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med 28: 1747–1753

    Article  PubMed  Google Scholar 

  16. Fietsam R, Villalba M, Glover JL, Clark K (1989) Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg 55: 396–402

    PubMed  Google Scholar 

  17. Friedlander MH, Simon RJ, Ivatury R et al. (1998) Effect of hemorrhage on superior mesenteric artery flow during increased intra-abdominal pressures. J Trauma 45: 433–489

    PubMed  Google Scholar 

  18. Gattinoni L, Pelosi P, Suter PM et al. (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? J Respir Crit Care Med 158: 3–11

    Google Scholar 

  19. Gattinoni L, Chiumello D, Carlesso E, Valenza F (2004) Bench-to-bedside review: chest wall elastance in acute lung injury/acute respiratory distress syndrome patients. Crit Care 8: 350–355

    Article  PubMed  Google Scholar 

  20. Gracias VH, Braslow B, Johnson J, Pryor J et al. (2002) Abdominal compartment syndrome in the open abdomen. Arch Surg 137: 1298–1300

    Article  PubMed  Google Scholar 

  21. Gudmundsson FF, Viste A, Gislason H, Svanes K (2002) Comparison of different methods for measuring intra-abdominal pressure. Intensive Care Med 28: 509–514

    Article  PubMed  Google Scholar 

  22. Harrahill M (1998) Intra-abdominal pressure monitoring. J Emerg Nurs 24: 465–466

    Article  PubMed  Google Scholar 

  23. Heinricius G (1890) Ueber den Einfluss der Bauchfuellung auf Circulation und Respiration. Z Biol 26: 113–202

    Google Scholar 

  24. Hobson KG, Young KM, Ciraulo A et al. (2002) Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma 53: 1129–1134

    PubMed  Google Scholar 

  25. Hong JJ, Cohn SM, Perez JM et al. (2002) Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 89: 591–596

    Article  PubMed  Google Scholar 

  26. Iberti TJ, Kelly KM, Gentili DR et al. (1987) A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 15: 1140–1142

    PubMed  Google Scholar 

  27. Ivatury RR, Diebel L, Porter JM, Simon RJ (1997) Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 77: 783–800

    Article  PubMed  Google Scholar 

  28. Ivatury RR, Porter JM, Simon RJ et al. (1998) Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 44: 1016–1021

    PubMed  Google Scholar 

  29. Jernigan TW, Fabian TC, Croce MA et al. (2003) Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 238: 349–355

    PubMed  Google Scholar 

  30. Joseph DK, Dutton RP, Aarabi B, Scalea TM (2004) Decompressive laparotomy to treat intractable intracranial hypertension after traumatic brain injury. J Trauma 57: 687–693

    PubMed  Google Scholar 

  31. Kashtan J, Green JF, Parsons EQ, Holcroft JW (1981) Hemodynamic effect of increased abdominal pressure. J Surg Res 30: 249–255

    Article  PubMed  Google Scholar 

  32. Kirkpatrick AW, Brenneman FD, McLean RF et al. (2000) Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? [see comments]. Can J Surg 43: 207–211

    PubMed  Google Scholar 

  33. Kopelman T, Harris C, Miller R, Arrillaga A (2000) Abdominal compartment syndrome in patients with isolated extraperitoneal injuries. J Trauma 49: 744–747

    PubMed  Google Scholar 

  34. Kron IL, Harman PK, Nolan SP (1984) The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 199: 28–30

    PubMed  Google Scholar 

  35. Latenser BA, Kowal-Vern A, Kimball D et al. (2002) A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil 23: 190–195

    Article  PubMed  Google Scholar 

  36. Lichtwarck-Aschoff M, Zeravik J, Pfeiffer UJ (1992) Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation [see comments]. Intensive Care Med 18: 142–147

    Article  PubMed  Google Scholar 

  37. Malbrain ML (1999) Abdominal pressure in the critically ill: measurement and clinical relevance. Intensive Care Med 25: 1453–1458

    Article  PubMed  Google Scholar 

  38. Malbrain ML (2004) Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 30: 357–371

    Article  PubMed  Google Scholar 

  39. Malbrain ML (2004) Validation of a novel fully automated continuous method to measure intra-abdominal pressure (IAP). Intensive Care Med 29: S73–73

    Google Scholar 

  40. Malbrain ML, Chiumello D, Pelosi P et al. (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30: 822–829

    Article  PubMed  Google Scholar 

  41. Malbrain ML, Chiumello D, Pelosi P et al. (2005) Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33: 315–322

    Article  PubMed  Google Scholar 

  42. Mayberry JC, Goldman RK, Mullins RJ et al. (1999) Surveyed opinion of American trauma surgeons on the prevention of the abdominal compartment syndrome. J Trauma 47: 509–513

    PubMed  Google Scholar 

  43. McNelis J, Marini CP, Jurkiewicz A et al. (2002) Predictive factors associated with the development of abdominal compartment syndrome in the surgical intensive care unit. Arch Surg 137: 133–136

    Article  PubMed  Google Scholar 

  44. Meldrum DR, Moore FA, Moore EE et al. (1997) Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 174: 667–672

    Article  PubMed  Google Scholar 

  45. Piacentini E, Villagra A, Lopez-Aguilar J, Blanch L (2004) Clinical review: the implications of experimental and clinical studies of recruitment maneuvers in acute lung injury. Crit Care 8: 115–121

    Article  PubMed  Google Scholar 

  46. Pusajo JF, Bumaschny E, Agurrola A et al. (1994) Postoperative intra-abdominal pressure: its relation to splanchnic perfusion, sepsis, multiple organ failure and surgical reintervention. Int Crit Care Dig 13: 2–4

    Google Scholar 

  47. Quintel M, Pelosi P, Caironi P et al. (2004) An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury. Am J Respir Crit Care Med 169: 534–541

    Article  PubMed  Google Scholar 

  48. Rasmussen IB, Berggren U, Arvidsson D et al. (1995) Effects of pneumoperitoneum on splanchnic hemodynamics: an experimental study in pigs. Eur J Surg 161: 819–826

    PubMed  Google Scholar 

  49. Ravishankar N, Hunter J (2005) Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study. Br J Anaesth 94: 763–766

    Article  PubMed  Google Scholar 

  50. Rezende-Neto JB, Moore EE, Melo de Andrade MV et al. (2002) Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure. J Trauma 53: 1121–1128

    PubMed  Google Scholar 

  51. Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ (1995) Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma 39: 1071–1075

    PubMed  Google Scholar 

  52. Samel ST, Neufang T, Mueller A et al. (2002) A new abdominal cavity chamber to study the impact of increased intra-abdominal pressure on microcirculation of gut mucosa by using video microscopy in rats. Crit Care Med 30: 1854–1858

    Article  PubMed  Google Scholar 

  53. Schachtrupp A, Toens C, Hoer J et al. (2002) A 24-h pneumoperitoneum leads to multiple organ impairment in a porcine model. J Surg Res 106: 37–45

    Article  PubMed  Google Scholar 

  54. Schachtrupp A, Fackeldey V, Klinge U et al. (2002) Temporary closure of the abdominal wall (laparostomy). Hernia 6: 155–162

    Article  PubMed  Google Scholar 

  55. Schachtrupp A, Hoer J, Toens C et al. (2002) Intra-abdominal pressure: a reliable criterion for laparostomy closure? Hernia 6(3): 102–107

    Article  PubMed  Google Scholar 

  56. Schachtrupp A, Graf J, Tons C et al. (2003) Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension. J Trauma 55: 734–740

    PubMed  Google Scholar 

  57. Schachtrupp A, Toens C, Fackeldey V et al. (2003) Evaluation of two novel methods for the direct measurement of the intra-abdominal pressure in a porcine model. Intensive Care Med 29: 1605–1608

    Article  PubMed  Google Scholar 

  58. Schachtrupp A, Lawong G, Afify M et al. (2005) Fluid resuscitation preserves cardiac output but cannot prevent organ damage in a porcine model during 24 h of intraabdominal hypertension. Shock 24: 153–158

    Article  PubMed  Google Scholar 

  59. Schein M (2002) Surgical management of intra-abdominal infection: is there any evidence? Langenbecks Arch Surg 387: 1–7

    Article  PubMed  Google Scholar 

  60. Stone PA, Hass SM, Flaherty SK et al. (2004) Vacuum-assisted fascial closure for patients with abdominal trauma. J Trauma 57: 1082–1086

    PubMed  Google Scholar 

  61. Sugerman H, Windsor A, Bessos M, Wolfe L (1997) Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med 241: 71–79

    Article  PubMed  Google Scholar 

  62. Sugrue M (2002) Intra-abdominal pressure: time for clinical practice guidelines? Intensive Care Med 28: 389–391

    Article  PubMed  Google Scholar 

  63. Sugrue M, Jones F, Deane SA et al. (1999) Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 134: 1082–1085

    Article  PubMed  Google Scholar 

  64. Sugrue M, Bauman A, Jones F et al. (2002) Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 26: 1428–1431

    Article  PubMed  Google Scholar 

  65. Suwanvanichkij V, Curtis JR (2004) The use of high positive end-expiratory pressure for respiratory failure in abdominal compartment syndrome. Respir Care 49: 286–290

    PubMed  Google Scholar 

  66. Tiwari A, Haq AI, Myint F, Hamilton G (2002) Acute compartment syndromes. Br J Surg 89: 397–412

    Article  PubMed  Google Scholar 

  67. Toens C, Schachtrupp A, Hoer J et al. (2002) A porcine model of the abdominal compartment syndrome. Shock 18: 316–321

    Article  PubMed  Google Scholar 

  68. Tons C, Schachtrupp A, Rau M et al. (2000) Abdominelles Kompartmentsyndrom: Vermeidung und Behandlung. Chirurg 71: 918–926

    Article  PubMed  Google Scholar 

  69. Tzelepis GE, Nasiff L, McCool FD, Hammond J (1996) Transmission of pressure within the abdomen. J Appl Physiol 81: 1111–1114

    PubMed  Google Scholar 

  70. Wendt E (1876) Ueber den Einfluss des intraabdominalen Druckes auf die Absonderungsgeschwindigkeit des Harns. Arch Physiol Heilkd 57: 527–575

    Google Scholar 

  71. World Society on Abdominal Compartment Syndrome (WSACS) (2005) Consensus definitions and recommendations. http://www.wsacs.org/. Cited 29 March 2006

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  1. Klinik für Allgemein-, Gefäß- und Viszeral-Chirurgie, Marienhospital, Rochusstr. 2, 40479, Düsseldorf

    A. Schachtrupp

  2. Chirurgische Universitätsklinik und Poliklinik, RWTH, Aachen

    A. Schachtrupp, M. Jansen, P. Bertram & V. Schumpelick

  3. Klinik für Operative Intensivmedizin, RWTH, Aachen

    R. Kuhlen

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  1. A. Schachtrupp
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Schachtrupp, A., Jansen, M., Bertram, P. et al. Abdominelles Kompartmentsyndrom. Anaesthesist 55, 660–667 (2006). https://doi.org/10.1007/s00101-006-1019-2

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