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Abdominal compartment syndrome (Schwartz p.216) - Coggle Diagram
Abdominal compartment syndrome
(Schwartz p.216)
Def.
intra-abdominal hypertension sufficient to
produce physiologic deterioration
Diagnosis
History
Ex.
Measurement of intraabdominal pressure
The most common technique is to measure the patient’s bladder pressure.
Technique
Measuring intra-abdominal pressure (IAP) through bladder pressure is a common and non-invasive technique utilized in clinical settings, particularly for patients in critical care, surgery, and trauma. This method is based on the premise that the pressure within the bladder can serve as a surrogate for pressure in the abdominal cavity. Here’s a brief overview of the technique:
Technique for Measuring Intra-Abdominal Pressure via Bladder Pressure
Preparation:
Ensure the patient is in a supine position.
Use sterile technique to minimize the risk of infection.
Empty the bladder before the measurement, which may involve catheterizing the patient if they are not already catheterized.
Catheter Placement:
Insert a Foley catheter into the bladder if not already in place.
Ensure that the catheter has a closed drainage system to avoid any changes in pressure due to urine drainage.
Manometer Setup:
Connect the Foley catheter to a pressure transducer or manometer.
The transducer should be zeroed at the level of the patient's symphysis pubis, which is considered the reference point for measuring IAP.
Measurement:
With the patient in a relaxed state (preferably during expiration), take the reading from the manometer.
Record the bladder pressure in mmHg. The procedure should be done while the patient is at rest, to avoid fluctuations due to abdominal muscle contractions or respiratory movements.
Calculating IAP:
The recorded bladder pressure is considered equivalent to the intra-abdominal pressure in a healthy patient and can be used for clinical assessments or treatment decisions.
Interpreting Results:
Normal IAP is typically considered to be between 0-5 mmHg. Values above 12 mmHg may indicate intra-abdominal hypertension, and values above 20 mmHg are often associated with abdominal compartment syndrome.
Considerations
Limitations: Bladder pressure can be affected by factors such as patient positioning, bladder volume, and the presence of urine. Proper technique and consistent conditions are crucial for accurate measurements.
Repeat Measurements: For patients at risk of intra-abdominal hypertension, repeated measurements may be necessary to monitor trends and make clinical decisions.
Patient Factors: Consider any conditions that might alter normal physiology, including obesity, ascites, or recent surgeries.
This method is widely accepted and has been validated in various studies, making it a practical choice for continuous monitoring in clinical practice. Proper training and adherence to protocol are essential to ensure accurate and reliable results.
Conditions in which the bladder pressure is unreliable
Generally, no specific bladder pressure prompts therapeutic intervention, except when the pressure is >35 mm Hg
end-organ sequelae as
decreased urine output
, decreased cardiac preload
increased cardiac afterload.
increased pulmonary inspiratory pressures
A diagnosis of intra-abdominal hypertension cannot reliably be made by physical examination; therefore, it is obtained by measuring the intraperitoneal pressure
TTT
emergent decompression is carried out when intra-abdominal hypertension reaches a level at which end-organ dysfunction occurs
decompression is performed operatively, either in the ICU
if the patient is hemodynamically unstable or in the OR