G3 IAH and ACS

Abdominal
Intra-abdominal Compartment
Hypertension Syndrome
Overview
What is Intra-Abdominal Pressure?

Intra-abdominal pressure (IAP) is the steady state pressure concealed within the
abdominal cavity. For most critically ill patients, an IAP of 5 to 7 mmHg is considered
normal.
Overview
What is Intra-Abdominal Hypertension?

Intra-abdominal hypertension (IAH) is defined by intra-abdominal
pressures (IAPs) of greater than 12 mmHg. Abdominal compartment
syndrome (ACS) is defined as an IAP of greater than 20 mm Hg with at least
one concomitant organ failure.
Types of Intra-Abdominal Hypertension
(according to severity)
Grade 1 Grade 2 Grade 3
12 – 15 mmHg 16 – 20 mmHg 21 – 25 mmHg

Overview
Intra-Abdominal Hypertension
Overview
What is Abdominal Compartment syndrome?
A medical emergency that can occur in critically ill people. It happens when swelling and
pressure in the belly (abdomen) reach dangerous levels. It refers to organ dysfunction
caused by intra-abdominal hypertension. It may be underrecognized because it primarily
affects patients who are already quite ill and whose organ dysfunction may be incorrectly
ascribed to progression of the primary illness (which is IAH).
Normal intra-abdominal pressure ranges between 0 and 5 millimeters of mercury (mmHg).

In critically ill people, the range is between 5 and 7 mmHg. High intra-abdominal pressure
may be defined as:
Intra-abdominal hypertension (IAH), in which pressure is 12 to 20 mmHg. (> 10 in children)
Abdominal compartment syndrome (ACS), in which pressure is higher than 20 mmHg.
can prevent organs and muscles from getting enough blood and oxygen.
WHAT
HAPPENS IN
COMPARTMENT
SYNDROME?
Groups of organs or
muscles are organized
into areas called
compartments. Strong After an injury, blood or edema (fluid resulting from inflammation or
webs of connective injury) may accumulate in the compartment. The tough walls of fascia
cannot easily expand, and compartment pressure rises, preventing
tissue called fascia form
adequate blood flow to tissues inside the compartment. Severe tissue
the walls of these damage can result, with loss of body function or even death.
compartments.
The legs, arms, and abdomen are most prone to developing compartment
syndrome.
Categories of Abdominal
compartment syndrome
Primary Secondary Tertiary
intra-abdominal occurs in the

injuries outside the
pathology is directly presence of
abdomen cause
and proximally cirrhosis and ascites
responsible fluid accumulation or related disease
Abdominal compartment syndrome
PATHOPHYSIOLOGY
Organ dysfunction with abdominal compartment syndrome is a product of
the effects of IAH on multiple organ systems. Abdominal compartment
syndrome follows a destructive pathway similar to compartment syndrome
of the extremity.
Organ level due to direct compression

intestinal tract and portal-caval system = COLLAPSE
thrombosis or bowel wall edema translocation of bacteria
additional fluid accumulation = INCREASED IAP
Cellular level due to impaired oxygen delivery

ISCHEMIA and ANAEROBIC METABOLISM
Vasoactive substances endothelial permeability
further capillary leakage impairs RBC transport = ISCHEMIA WORSENS
PATHOPHYSIOLOGY
Although the abdominal cavity (ie, the peritoneal and, to a lesser
extent, retroperitoneal cavities) is much more distensible than an
extremity, it reaches an endpoint at which the pressure rises
dramatically. This is less apparent in chronic cases because the fascia
and skin slowly stretch and thus tolerate greater fluid accumulation.
As pressure rises,
Cardiovascular and Pulmonary systems = IMPAIRED
Intra-Cranial Pressure = INCREASED
PATHOGENESIS
PATHOGENESIS
PATHOGENESIS
ETIOLOGY
Primary
CHRONIC
SECONDAry
Penetrating trauma
Peritoneal dialysis
Intraperitoneal hemorrhage Large-volume resuscitation
Morbid obesity
Pancreatitis Large areas of full-
Cirrhosis
External compressing forces, thickness burns
Meigs syndrome
such as debris from a motor Penetrating or blunt trauma
Intra-abdominal mass
vehicle collision or after a without identifiable injury
large structure explosion Postoperative
Pelvic fracture Packing and primary fascial
Rupture of abdominal aortic closure, which increases
aneurysm incidence
Perforated peptic ulcer Sepsis
SIGNS AND SYMPTOMS
3 Cardinal Signs
ABDOMINAL OLIGURIA
DISTENSION DYSPNEA
SIGNS AND SYMPTOMS
HYPOTENSION
ABDOMINAL
PAIN
SWOLLEN, TIGHT
BELLY DIFFICULTY OLIGURIA
BREATHING
DIAGNOSTIC TESTS
The only way to
confirm the diagnosis
of ACS is to measure
intra-abdominal
pressure.

The current method

for measuring intra-
abdominal pressure is
to measure bladder
pressure.
DIAGNOSTIC TESTS
Bladder Technique
1. Insert a thin, flexible tube (catheter)
into the tube that transports urine
out of the body (urethra).
2. Advance the catheter to the
bladder.
3. Attach the catheter to a bag of
fluid.
4. Use a syringe to inject the fluid into
the bladder.
5. Measure the pressure.
This test will be repeated so the
healthcare team can tell if the
condition is getting worse or better.
DIAGNOSTIC TESTS
Laboratory Tests
This can measure certain chemicals
and gasses in your body.
This can provide pictures of the

inside of your abdomen
This test uses a simple clamp on the

outside of your finger to see whether
your body is getting enough oxygen.
TREATMENT MILD
1. Fluid restriction
2. Medications: diuretics and analgesics
MODERATE
1. Paracentesis
2. Gastric decompression using Ryle’s tube
3. Bowel decompression using rectal catheter
4. Bladder decompression using Foley’s catheter
TREATMENT SEVERE
1. Stop enteral nutrition to avoid GI overload
2. Temporary neuromuscular blockade to paralyze the abdominal
muscle walls (Increases elasticity of abdominal wall)
3. Decompressive surgery
4. Complication of the surgery: Reperfusion Syndrome
The most effective abdominal compartment syndrome treatment

is surgical decompression of abdomen. The surgeon will perform
a procedure called decompressive laparotomy. They'll make a cut
(incision) through your skin and abdominal wall to open the area
and release pressure.
Intra-abdominal pressure decreases in the hours after surgery.

But it may take several days for the pressure to reach a near-
normal level. The incision may not be fully closed until this
happens. Some people may require repeat abdominal
decompression surgery.
Nursing Diagnosis
NURSING
01 Impaired Gas exchange related
to increased intra-abdominal
CARE
pressure
PLAN
Objective of Care
Demonstrate Report absence

improved of symptoms of
ventilation and respiratory
adequate distress (i.e.
oxygenation of dyspnea)
tissues by ABGs
within client’s
usual parameters
Intervention
Monitor oxygen saturation continuously with pulse oximeter and
ABGs. Note the trend of these values.
Prepare initiation of delivery of supplemental oxygen

through intubation and mechanical ventilator as
ordered by the physician.
Monitor and adjust ventilator settings as

indicated when mechanical support is being
used.
Assist in administering neuromuscular blocking agents, as ordered by
the physician.
Prepare the patient for surgical procedure (decompressive
laparotomy) as indicated. Preparation involves educating the patient,
gaining their consent, and accomplishing a pre-operative checklist.
Administer analgesics as ordered by the physician.
Teach breathing techniques specifically such as deep
breathing.
Position patient in a supine position.
Regularly check the patient’s position so that they do not
slump down in bed.
Evaluation
Slight improvement in ventilation, the
oxygen saturation level is at 94%. ABGs
within the borderline of client’s usual
parameters
Absence of symptoms of respiratory

distress (i.e. dyspnea) was shown.

G3 IAH and ACS

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Abdominal

What is Intra-Abdominal Pressure?

What is Intra-Abdominal Hypertension?

Grade 1 Grade 2 Grade 3

12 – 15 mmHg 16 – 20 mmHg 21 – 25 mmHg

Normal intra-abdominal pressure ranges between 0 and 5 millimeters of mercury (mmHg).

Primary Secondary Tertiary

intra-abdominal occurs in the

Organ level due to direct compression

Cellular level due to impaired oxygen delivery

The current method

This can provide pictures of the

This test uses a simple clamp on the

The most effective abdominal compartment syndrome treatment

Intra-abdominal pressure decreases in the hours after surgery.

Demonstrate Report absence

Prepare initiation of delivery of supplemental oxygen

Monitor and adjust ventilator settings as

Absence of symptoms of respiratory

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