Intra-abdominal Hypertension and Abdominal Compartment Syndrome

Increased intra-abdominal pressure (IAP), also referred to as intra-abdominal hypertension (IAH), affects organ function in critically ill patients and may lead to abdominal compartment syndrome (ACS). Although initially described in surgical patients, IAH and ACS also occur in medical patients without abdominal conditions. IAP can be measured easily and reliably in patients through the bladder using simple tools. The effects of increased IAP are multiple, but the kidney is especially vulnerable to increased IAP because of its anatomic position. Although the means by which kidney function is impaired in patients with ACS is incompletely elucidated, available evidence suggests that the most important factor involves alterations in renal blood flow. IAH should be considered as a potential cause of acute kidney injury in critically ill patients; its role in other conditions, such as hepatorenal syndrome, remains to be elucidated. Because several treatment options (both medical and surgical) are available, IAH and ACS should no longer be considered irrelevant epiphenomena of severe illness or critical care. An integrated approach targeting IAH may improve outcomes and decrease hospital costs, and IAP monitoring is a first step toward dedicated IAH management. IAH prevention, most importantly during abdominal surgery but also during fluid resuscitation, may avoid ACS altogether. However, when ACS occurs and medical treatment fails, decompressive laparotomy is the only option. Am J Kidney Dis. 57(1): 159-169. (C) 2010 by the National Kidney Foundation, Inc.