open access

Vol 49, No 2 (2017)
Review articles
Published online: 2017-05-14
Submitted: 2017-03-05
Accepted: 2017-05-01
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Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

Alexsander K. Bressan, Chad G. Ball
DOI: 10.5603/AIT.a2017.0024
·
Pubmed: 28513820
·
Anaesthesiol Intensive Ther 2017;49(2):159-166.

open access

Vol 49, No 2 (2017)
Review articles
Published online: 2017-05-14
Submitted: 2017-03-05
Accepted: 2017-05-01

Abstract

Intra-abdominal hypertension, even preceding the onset of abdominal compartment syndrome, is still recognized as an adverse prognostic factor. Unfortunately, most of the current supporting evidence within the critical care environment remains observational in nature. In acute pancreatitis, an active role for intra-abdominal hypertension early in the disease process follows a strong intuitive basis, and it is corroborated by preliminary evidence from animal models. Additional studies are needed to better characterize the optimal fluid resuscitation strategy, as well as the importance of intra-abdominal hypertension as an early therapeutic target. All critically ill patients with acute pancreatitis should be considered for routine intra-abdominal pressure monitoring. The prevalence and clinical relevance of intra-abdominal hypertension after elective major abdominal operations are underestimated in the literature. Hepato-pancreato-biliary surgery and liver transplantation represent high-risk surgical subspecialties, and routine intra-abdominal hypertension risk assessment to indicate postoperative intra-abdominal pressure monitoring can be recommended. Conservative management of intra-abdominal hypertension should be promptly initiated upon diagnosis. Although abdominal catheter drainage and decompressive laparotomy may be required in refractory cases based on expert clinical judgment, precise indications and timing are still unclear. Implementation of institutional protocols based on the Abdominal Compartment Society reference standards is crucial to optimize both clinical management and research in this evolving area.

Abstract

Intra-abdominal hypertension, even preceding the onset of abdominal compartment syndrome, is still recognized as an adverse prognostic factor. Unfortunately, most of the current supporting evidence within the critical care environment remains observational in nature. In acute pancreatitis, an active role for intra-abdominal hypertension early in the disease process follows a strong intuitive basis, and it is corroborated by preliminary evidence from animal models. Additional studies are needed to better characterize the optimal fluid resuscitation strategy, as well as the importance of intra-abdominal hypertension as an early therapeutic target. All critically ill patients with acute pancreatitis should be considered for routine intra-abdominal pressure monitoring. The prevalence and clinical relevance of intra-abdominal hypertension after elective major abdominal operations are underestimated in the literature. Hepato-pancreato-biliary surgery and liver transplantation represent high-risk surgical subspecialties, and routine intra-abdominal hypertension risk assessment to indicate postoperative intra-abdominal pressure monitoring can be recommended. Conservative management of intra-abdominal hypertension should be promptly initiated upon diagnosis. Although abdominal catheter drainage and decompressive laparotomy may be required in refractory cases based on expert clinical judgment, precise indications and timing are still unclear. Implementation of institutional protocols based on the Abdominal Compartment Society reference standards is crucial to optimize both clinical management and research in this evolving area.

Get Citation

Keywords

intra-abdominal hypertension; abdominal compartment syndrome; acute pancreatitis; hepatopancreatobiliary surgery; liver transplantation

About this article
Title

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 2 (2017)

Pages

159-166

Published online

2017-05-14

DOI

10.5603/AIT.a2017.0024

Pubmed

28513820

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(2):159-166.

Keywords

intra-abdominal hypertension
abdominal compartment syndrome
acute pancreatitis
hepatopancreatobiliary surgery
liver transplantation

Authors

Alexsander K. Bressan
Chad G. Ball

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