Acute abdominal compartment syndrome in the critically ill

Acute abdominal compartment syndrome (ACS) is a clinical entity that develo ps from a progressive, acute increase in pressure within the confined space of the abdominal cavity from a multitude of etiologies. This increase in i ntra-abdominal pressure (IAP) impacts multiple organ systems in a graded fa shion due to differential susceptibilities. While the classic renal, pulmon ary, and cardiovascular signs are seen with marked elevations in IAP, we no w know that the gut is most sensitive to increases in IAP and develops evid ence of endorgan damage earlier in the development of ACS. Furthermore, int racranial derangements with ACS are now well described. Treatment involves expedient decompression of the abdomen, without which the syndrome of end-o rgan damage and reduced oxygen delivery may lead to the development of mult iple organ failure and ultimately death. The scenarios of multiple trauma, hemorrhage with massive volume resuscitation, and/or protracted operation a re where ACS is most frequently encountered. However, knowledge of ACS is a lso essential for the management of critically ill pediatric patients and i ntensive care patients with acute medical illnesses. The role of intra-abdo minal hypertension (IAH) in the etiology of necrotizing enterocolitis, cent ral obesity comorbidities, and preeclampsia/eclampsia remains to be fully e lucidated. This article reviews the experimental background, organ system p athophysiology, diagnosis, and treatment of ACS with emphasis on the latest concepts in the literature as they apply to critically ill patients.