abdominal compartment syndrome | The Journal of Critical Care Medicine

Intraabdominal hypertension is less common than it used to be: A pilot step wedge trial

Shane Smith¹^,²^,³, Fran Priestap³, Neil Parry¹^,²^,³, Robert Arntfield⁴, Patrick Murphy⁵, Kelly Vogt²^,³, Ian Ball¹^,³^,⁴

1 Office of Academic Military Medicine, Western University, London, Ontario, Canada
2 Department of Surgery, Western University, London, Ontario, Canada
3 London Health Sciences Centre Trauma Program, London, Ontario, Canada
4 Department of Medicine, Western University, London, Ontario, Canada
5 Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

DOI: 10.2478/jccm-2025-0002

Objective: This is a pilot study to determine the feasibility of a multicentre stepped wedge cluster randomized trial of implementing the 2013 World Society of the Intraabdominal Compartment Syndrome (WSACS) guidelines as an intervention to treat intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in critically ill patients.
Design: Single-centre before-and-after trial, with an observation / baseline period of 3 months followed by a 9-month intervention period.
Setting: A 35 bed medical-surgical-trauma intensive care unit in a tertiary level, Canadian hospital.
Patients: Recruitment from consecutively admitted adult intensive care unit patients.
Intervention: In the intervention period, treatment teams were prompted to implement WSACS interventions in all patients diagnosed with IAH.
Measurements and Main Results: 129 patients were recruited, 59 during the observation period and 70 during the intervention period. Only 17.0% and 12.9%, respectively, met diagnostic criteria for IAH. Many recruited patients did not have intraabdominal pressures measured regularly per study protocol. There was no difference in ICU mortality for patients in either cohort or between those with and without IAH.
Conclusions: The incidence of IAH in our patient population has decreased significantly since 2015. This is likely due to a significant change in routine care of critically ill patients, especially with respect to judicious goal-directed fluid resuscitation. Patient recruitment and protocol adherence in this study were low, exacerbated by other staffing and logistical pressures during the study period. We conclude that a larger multicentre trial is unlikely to yield evidence of a detectable treatment effect.

Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review

Gabriel Alexandru Popescu^1,2, Tivadar Bara jr.^1,2, Paul Rad^1,3

1 University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania
2 Surgery Clinic No. 2, Târgu Mureş, Romania
3 Anesthesiology and Intensive Care Clinic No. 1, Târgu Mureş, Romania

DOI: 10.2478/jccm-2018-0024

Abdominal Compartment Syndrome (ACS), despite recent advances in medical and surgical care, is a significant cause of mortality. The purpose of this review is to present the main diagnostic and therapeutic aspects from the anesthetical and surgical points of view. Intra-abdominal hypertension may be diagnosed by measuring intra-abdominal pressure and indirectly by imaging and radiological means. Early detection of ACS is a key element in the ACS therapy. Without treatment, more than 90% of cases lead to death and according with the last reports, despite all treatment measures, the mortality rate is reported as being between 25 and 75%. There are conflicting reports as to the importance of a conservative therapy approach, although such an approach is the central to treatment guidelines of the World Society of Abdominal Compartment Syndrome, Decompressive laparotomy, although a backup solution in ACS therapy, reduces mortality by 16-37%. The open abdomen management has several variants, but negative pressure wound therapy represents the gold standard of surgical treatment.