Beruflich Dokumente
Kultur Dokumente
HYPERTENTION &
ABDOMINAL
COMPARTMENT
Aditya Bhayusakti, M.D
SYNDROME
important values
Hyperacute(sec,min):laughing,strain,coughing,sneez,physical activities)
Acute(couple H):trauma,hge
Subacute (couple days): most medical
cases.
Chronic: morbid obesity,intraabdominal
tumor,pregnancy.
pancreatitis
pneumoperitoneum
neoplasm
massive intra-abdominal
retroperitoneal hemorrhage,
intestinal obstruction
IVC
Flow
DIAPHRAGMATIC
ELEVATION
DIRECT ORGAN
COMPRESSION
Cardiac
Intrathoracic
compression
pressure
CARDIAC OUTPUT
Splanchnic
Vascular Resistance
ABDOMINAL WALL
ISCHAEMIA/OEDEMA
RESPIRATORY
FAILURE
ICP SPLANCHNIC
ISCHAEMIA
Cardiovascul
ar
Implications
Central
nervous
system
Implications
Effects on CVS
mechanical ventilation
often necessary
high peak airway
pressures ?barotrauma
high PEEP often
required further
compromising CO
Renal effects
Experimental
Control
20
Aldosterone level
(ng/dl)
15
10
5
0
0
10
15
20
25
Fluids
(ng/ml/hr)
Experimental
Control
30
25
20
15
10
5
0
0
10
15
20
25
Fluids
IAH
Coagulopathy
hypothermia
Unrelieved
acidosis
Intraabdominal
bleeding
ACS
pp
Baseline
Bowel 5
TPO2
Axillary
TPO2
3
1
0
20
40
60
80
100
EFFECTS ON CNS
Intracranial Derangements
and IAH
ICP
CPP
cerebral ischaemia
? Why?
may be due to
impairment of cerebral
venous outflow
Measurement of I A P
Measurement of IAP
Direct
Indirect
Direct Monitoring
Indirect Monitoring
Bladder Pressure
Monitoring
Indication of
surgical
decompression
10-15
No evidence of
ACS
II
15-25
Based on patient
condition
III
25-35
Decompression
indicated
IV
>35
Immediate
decompression
Pressure
Grade
Management
10-15 mm Hg
maintain
normovolemia
16-25 mmHg
II
Hypervolemic
resuscitation
26-35 mmHg
III
decompression
> 35 mm Hg
IV
decompression
and reexploration
CT findings
ICP
CPP
Management of ACS
Prevention
vs.
Formal Closure?
Management
Prevention Adequate resuscitation
Adequate ventilation
Identification
of patients at risk
Monitoring
Non-surgical
interventions
Paracentesis
Neuromuscular blockade
CNAP
Gut emptying
Octreotide
MEDICAL
DECOMPRESSION
Management
Prevention Adequate resuscitation
Adequate ventilation
Identification
of patients at risk
Monitoring
Non-surgical
interventions
Paracentesis
Neuromuscular blockade
CNAP
Gut emptying
Octreotide
Prognosis
THANK YOU