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World J Gastroenterol. Jan 21, 2020; 26(3): 266-278
Published online Jan 21, 2020. doi: 10.3748/wjg.v26.i3.266
Abdominal compartment syndrome: Often overlooked conditions in medical intensive care units
Venkat Rajasurya, Salim Surani
Venkat Rajasurya, Department of Pulmonary and Critical Care, Novant Health System, Winston-Salem, NC 27103, United States
Salim Surani, Department of Pulmonary Critical Care and Sleep Medicine, Texas A&M Health Science Center, Bryan, TX 77807, United States
Author contributions: All authors have contributed to the preparation of manuscript, literature search and review of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Salim Surani, MD, MPH, NSHM, FACP, FCCP, Adjunct Clinical Professor of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Texas A&M Health Science Center, 8441 Riverside Pkwy, Bryan, TX 77807, United States.
Received: November 25, 2019
Peer-review started: November 25, 2019
First decision: December 4, 2019
Revised: December 17, 2019
Accepted: January 2, 2020
Article in press: January 2, 2020
Published online: January 21, 2020

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome are well recognized entities among surgical patients. Nevertheless, a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units (ICU) and has been widely recognized as an independent risk factor for mortality. It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality. Frequently it is underdiagnosed and undertreated in this patient population. Elevated intra-abdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure. When intraabdominal hypertension is not promptly recognized and treated, it leads to abdominal compartment syndrome, multiorgan dysfunction syndrome and death. Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis, shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension. This article presents an overview of the epidemiology, definitions, risk factors, pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Keywords: Intra-abdominal pressure, Intra-abdominal hypertension, Abdominal compartment syndrome, Acute kidney injury, Large volume resuscitation, Open abdomen, Bladder pressure, Medical intensive care unit

Core tip: Intra-abdominal hypertension and abdominal compartment syndrome are very common in medical intensive care unit. Recognizing the risk factors for the development of intra-abdominal hypertension, timely measurement of intra-abdominal pressure and promptly implementing the resuscitation strategies can significantly reduce the morbidity and mortality associated with abdominal compartment syndrome.