Trauma Notebook Intra-abdominal pressure monitoring☆,☆☆,★,★★

Abdominal compartment syndrome is a potentially deadly condition that can be missed in the emergency department setting.

The purpose of this narrative review article is to provide a summary of the background, pathophysiology, diagnosis, and management of abdominal compartment syndrome with a focus on emergency clinicians.

Abdominal compartment syndrome is caused by excessive pressure within the abdominal compartment due to diminished abdominal wall compliance, increased intraluminal contents, increased abdominal contents, or capillary leak/fluid resuscitation. History and physical examination are insufficient in isolation, and the gold standard is intra-abdominal pressure measurement. Abdominal compartment syndrome is defined as an intra-abdominal pressure >20 mm Hg with evidence of end-organ injury. Management involves increasing abdominal wall compliance (e.g., analgesia, sedation, and neuromuscular blocking agents), evacuating gastrointestinal contents (e.g., nasogastric tubes, rectal tubes, and prokinetic agents), avoiding excessive fluid resuscitation, draining intraperitoneal contents (e.g., percutaneous drain), and decompressive laparotomy in select cases. Patients are critically ill and often require admission to a critical care unit.

Abdominal compartment syndrome is an increasingly recognized condition with the potential for significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.

L’utilité clinique de la mesure de la pression intra-abdominale (PIA) et les implications relatives à son élévation chez le patient agressé (hypertension intra-abdominale [HIA]) suscitent un intérêt croissant depuis quelques années. Notamment, l’impact délétère sur les plans respiratoire et hémodynamique d’une élévation soutenue de la PIA est désormais indéniable et commence à être mieux connu. Cette revue envisage d’abord certains des aspects physiopathologiques de l’HIA pour souligner l’importance de mesurer la PIA chez les patients présentant ou susceptibles de constituer un syndrome compartimental abdominal (SCA). Il s’agit ensuite de décrire les principales techniques de mesures de la PIA utilisables en pratique clinique. La méthode de mesure de la PIA actuellement recommandée pour une utilisation en pratique courante est la mesure discontinue de PIA via la pression intravésicale, dite « en milieu liquidien fermé ». En présence de contre-indications à la mesure de pression intravésicale (traumatisme vésical ou pelvien, vessie neurologique, chirurgie prostatique, chirurgie urologique basse avec adhérences pelviennes, vessie radique…), la mesure de pression intragastrique doit alors être préférée.

The clinical interest of intra-abdominal hypertension (IAH) and its deleterious effects is increasing since recent years. The respiratory and haemodynamic effects of an increase in intra-abdominal pressure (IAP) are certain. This work focuses on the pathophysiological consequences of an IAH and the description of the IAP measurement techniques the most routinely used. The IAP measurement method currently suggested by the international expert committees for a routine IAP monitoring is the closed-system repeated measurement technique, using intrabladder pressure measurement. When intrabladder pressure measurement is contra-indicated (e.g. past medical history of bladder pathology, bladder and pelvic trauma, neurogenic bladder, post-radic bladder, haematuria, prostate and low-urologic surgery…), intragastric pressure measurement should be used.