Intra-abdominal hypertension and multiple organ dysfunction syndrome

Mindaugas Šerpytis, Juozas Ivaškevičius

Clinic of Anesthesiology and Intensive Care, Vilnius University, Vilnius University Emergency Hospital, Lithuania

Key words: intra-abdominal pressure, intra-abdominal hypertension, abdominal compartment syndrome, multiple organ dysfunction syndrome.

Summary. In clinical practice, intra-abdominal pressure is usually measured indirectly via the urinary bladder using Foley catheter. This technique is minimally invasive, safe, simple and accurate. Intra-abdominal hypertension is defined as an intra-abdominal pressure above 12 mmHg. Rapid progression of intra-abdominal hypertension will lead to abdominal compartment syndrome, which is defined as an intra-abdominal pressure greater than 20 mmHg with at least one organ failure. The incidence of intra-abdominal hypertension is variable and depends on the values used to define it and on the study population. However, the mortality rate of intra-abdominal hypertension and abdominal compartment syndrome is high. Increase in intra-abdominal pressure causes significant impairment of almost all organ systems. Even slight increase in intra-abdominal pressure has negative influence on the respiratory, cardiovascular, cerebral, gastrointestinal, hepatic, and renal functions. Intra-abdominal hypertension causes visceral organ hypoperfusion, intestinal ischemia and may also lead to bacterial translocation, release of cytokines and production of free oxygen radicals. All these factors may contribute to the development of multiple organ failure in the critically ill patients. Intravascular fluid replacement and abdominal decompression are the standards of treatment for abdominal compartment syndrome.

Correspondence to M. Šerpytis, Clinic of Anesthesiology and Intensive Care, Vilnius University, Šiltnamių 29, 04130 Vilnius, Lithuania. E-mail: mindaugas.serpytis@santa.lt

Received 23 September 2005, accepted 15 November 2005