Multisystem organ failure secondary to increased intraabdominal pressure

Acutely increased intraabdominal pressure can lead to multisystem organ dys function. Organ dysfunction consists of acute pulmonary failure secondary t o compressive atelectasis and associated with high peak inspiratory pressur es and impaired gas exchange, acute renal failure with marked oliguria with out hypernaturia, intestinal and hepatic ischemia possibly leading to bacte rial translocation or necrosis with peritonitis, increased intracranial pre ssures which may cause brain dysfunction or aggravate head injury edema, ve nous thrombosis and thromboembolism, and abdominal wall ischemia or necrosi s. The diagnosis is made clinically in a patient,vith high peak inspiratory pressures, oliguria and an apparently tight abdomen, although urinary blad der pressure greater than or equal to 20 cm H2O pressure is suggestive. How ever, chronically increased intraabdominal pressure as is seen in the morbi dly obese, pregnancy and cirrhosis may be misleading. As to treatment, once the diagnosis is made, the patient's abdomen should be opened and the tens ion relieved. The intestinal contents need to be protected and evaporative water loss minimized by either closing the skin and not the fascia or, if t his is not possible, using an impermeable protective dressing. If the abdom en is difficult to close at the primary operation, it is best to prevent th e development of an acute abdominal compartment syndrome by closing only th e skin or leaving it open and using an impermeable dressing. In conclusion, the acute abdominal compartment syndrome has become increasingly recognize d as a cause for multisystem organ failure. Recognition of the problem or p revention is mandatory for optimal patient survival.