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R. Chawla and S.K. Dash

 

 

Cause

I

Decreased abdominal wall compliance

II

Increased intraluminal contents

III

Increased abdominal contents

IV

Increased capillary leak /fluid resuscitation

Measures

Adequate sedation and analgesia

Remove constrictive dressings, abdominal eschars

Avoid prone position, head of bed more than 20° Reverse Trendelenburg position

Neuromuscular blockade

Nasogastric and/or flatus tube

Gastrocolic prokinetic agents

Erythromycin (200 mg IV q 8 h), metoclopromide (10 mg IV q 6 h), or neostigmine (1–2 mg IV slow infusion)

Minimize enteral nutrition

Enemas

Colonoscopic decompression

Stop enteral nutrition

Percutaneous catheter drainage for fluid (indicated if IAP >20 cmHg), USG or CT guided

Surgical evacuation

Avoid excessive fluid resuscitation (use hypertonic fluids, colloids)

Aim zero to negative fluid balance by day 3

Diuresis once stable

Hemodialysis/ultrafiltration

Fig. 39.5 IAH/ACS management

Suggested Reading

1.Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg. 2009;33(6):1116–22.

This comprehensive review discusses the risk factors that predict the development of IAH/ACS, the appropriate measurement of IAP, and the current resuscitation options.

2.Irwin RS, Rippe JM. Irwin and Rippe’s intensive care medicine. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 1795–1803.

The chapter discusses the practical application of IAP monitoring in detail, with pictorial depiction of pathophysiology of raised IAP.

Website

1.www.wsacs.org

The all-in-one website for intra-abdominal hypertension and abdominal compartment syndrome

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