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Definitions

This chapter appears in the following book:

Abdominal Compartment Syndrome

Edited by: Rao Ivatury, Michael Cheatham, Manu Malbrain and Michael Sugrue
ISBN: 1-58706-196-1
» Get more information about this book at landesbioscience.com «

Chapter authors:
David J.J. Muckart, Rao Ivatury, Ari Lepp?niemi and R. Stephen Smith


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Within any human body compartment a rise in pressure above physiological limits is detrimental. At pressures which still permit axial vessel flow, capillary perfusion may cease to exist resulting in cell death. The physiological sequelae and development of signs and symptoms is dependent upon a number of factors, namely perfusion pressure, rate and magnitude of intracompartmental pressure rise, compliance of the compartment, and the reason for the change in compartmental pressure. A rapid exponential rise in intracranial pressure within the rigid skull in a hypotensive patient is rapidly fatal if urgent intervention is delayed, whereas chronic hydrocephalus in a child may have little, if any, effect on vital organ function. The same principles pertain to the abdomen. During laparoscopy with muscle relaxation IAP may rise acutely to 20mmHg or more without any overt interference in organ function.4 Conversely, in a swine model Simon et al showed that if IAP was elevated to 20mmHg following a period of haemorrhagic shock and resuscitation, there was a marked decrease in pulmonary function.5 Control animals with similar elevations in IAP but without prior haemorrhage had minimal changes in PaO2/FiO2 ratio. In humans, ACS as a result of rapid accumulation of intra-abdominal fluid has been documented following massive crystalloid resuscitation in the absence of intra-abdominal injury,6-9 whereas chronic ascites of up to 15 litres is well tolerated.10 From the above there appear to be certain preconditions for the development of a pathological rise in IAP. The change must be acute and there must be a prior insult which need not necessarily be intra-abdominal.

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Additional chapters from this book:

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Definitions

David J.J. Muckart, Rao Ivatury, Ari Lepp?niemi and R. Stephen Smith

Within any human body compartment a rise in pressure above physiological limits is detrimental. At pressures which still permit axial vessel flow, capillary perfusion may cease to exist resulting in...

Intra-Abdominal Hypertension and Renal Impairment

Michael Sugrue, Ali Hallal and Scott D’Amours

Intra-abdominal hypertension (IAH) has been associated with renal impairment for over 150 years. It is only recently however that a clinically recognised relationship has been found. An increasing n...

Medical Management of Abdominal Compartment Syndrome

Michael Parr and Claudia Olvera

The medical management of intra-abdominal hypertension (IAH) has been described as of limited efficacy making expedient surgical decompression the treatment of choice for abdominal compartment syndr...

Abdominal Compartment Syndrome in the Pediatric Patient

M. Ann Kuhn* and David W. Tuggle

For all practical purposes, the original clinical model for the abdominal compartment syndrome (ACS) involved the repair of congenital abdominal wall defects such as omphalocele (Fig. 1) and gastros...


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