الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Although initially recognized over 150 years ago, the pathophysiologic implications of elevated intra-abdominal pressure (IAP) have essentially been rediscovered only within the past two decades
IAH has been identified as a continuum of pathophysiologic changes beginning with regional blood flow disturbances and culminating in frank end-organ failure and the development of ACS. ACS has been identified to be a cause of significant morbidity and mortality among critically ill surgical, medical, and pediatric patients. Previously present, but significantly under-appreciated, IAH and ACS are now recognized as common occurrences in the intensive care unit (ICU) setting Elevated IAP has been identified as an independent predictor of mortality during critical illness and likely plays a major role in the development of multiple system organ failure, a syndrome which has plagued ICU patients and physicians for decades
Central to this evolving strategy are the use of early serial IAP measurements to detect the presence of IAH, application of comprehensive medical management strategies to reduce elevated IAP and restore end-organ perfusion, timely surgical abdominal decompression for refractory organ dysfunction, and early attempts at fascial closure once physiologically appropriate
In 2004, a consensus conference was convened by the World Society of the Abdominal Compartment Syndrome (WSACS) consisting of European, Australasian, and North American surgical, trauma, and medical critical care specialists. Recognizing the lack of accepted definitions, and the resulting confusion and difficulty in comparing studies published in this area, the WSACS tasked these specialists to create evidence-based consensus definitions and recommendations for the resuscitation and rehabilitation of patients with IAH and ACS. After extensively reviewing the existing literature, the authors suggested a conceptual framework for standardizing the definitions of IAH and ACS as well as a general technique for IAP monitoring based upon the current understanding of the pathophysiology of these two syndromes The following review addresses both the pathophysiologic impact of elevated IAP on the various organ systems as well as the currently accepted definitions surrounding IAH and ACS. The diagnosis, prevention, and treatment of IAH/ACS have been addressed in a number of recent publications