Prophylaxis and treatment of intra-abdominal hypertension in patients with acute surgical pathology of abdominal organs

Abstract

Acute abdominal pathology may cause a progressive, unchecked increase of intra-abdominal pressure up to the development of the abdominal compartment syndrome (ACS). The last one is associated with organ failure. The aim of this study was to optimise the nonsurgical ways of abdominal decompression to prevent ACS development in patients with the acute diseases of abdominal organs that cause intra-abdominal hypertension (IAH). Fifty-nine patients of the control group with acute abdominal pathology associated with IAH were studied retrospectively. In the study group, 71 patients with the same pathology, managed according to the proposed three stage approach, were evaluated prospectively. Bladder pressure was measured using the modified system. It permits zeroing of the system without direct contact with a sterile surgical field. The main cause of IAH was the abdominal content volume increase. According to the proposed treatment approach, management was started from the least invasive methods and proceeded to the next step in case of ineffectiveness. In patients, mechanical ventilation adjustment of ventilator’s parameters decreased abdominal pressure on average by 18.8 ± 2.6 mmHg; thus, in 19 patients, the average became less than 15 mmHg. First step measures permitted to stabilize the intra-abdominal pressure (IAP) on the target level in 39 (54.9%) cases. The second stage activities were effective in 19 (26.8%) cases. The most effective third step manoeuvre was the improvement of abdominal wall compliance. Described algorithm permitted to reduce IAP and escape surgical decompression in 67 (94.4%) cases. The incidence of complications was lower in the study group (22.5% vs 64.4% in control one, p<0.05). In general, postoperative mortality was 7.6% (all patients from the control group). To determine the optimal way of IAH/ACS management, it is necessary to clearly understand the causes of its development and underlying pathophysiological mechanisms in a particular case. Usage of the simplified algorithm for correction of intra-abdominal pressure has allowed a statistically significant reduction of the number of systemic and local complications in patients with urgent pathology of abdominal organs.