Editing Abdominal compartment syndrome (section)

== '''Management''' ==

=== IAH initial management: ===

* Treat aggressively to prevent progression to ACS - usually works
* Continue checking pressure q4-6h
* Evacuate intraluminal contents
** NGT +/- rectal tube, IDC
** Prokinetics
** Consider an enema to evacuate large stool burden
** Diurese
* Evacuate intra-abdominal spaces
** Drain ascites
* Improve abdo wall compliance
** Ensure good analgaesia
** Remove anything constrictive - abdo dressings/eschars
** Reverse Trendelenburg can be helpful
** Consider neuromuscular blockade - does decrease intra-abdominal pressure, but data is quite patchy, and blockade is contra-indicated in most patients anyway (increased VAP, peripheral nerve injury, skin breakdown and VTE)
* Optimise fluid administration
* Support at-risk organs 
** Lungs - use of lower mean airway pressures, lower than normal tidal volumes

=== Indications for surgical decompression: ===

* IAP > 20 and new organ dysfunction
** Inability to ventilate
** AKI
** Haemodynamic instability
** Metabolic failure
** GIT failure
** ICH

Sudden increase in pressure is worse than gradual

=== Decompressive laparotomy ===

* Generous midline from xiphisternum to pubis
* Avoid subcostal/paramedian incisions because much harder to manage in open abdomen stage
* Remember to warn intensivists/anaesthetist that laparotomy can be sudden reperfusion event - they will sometimes give bicarb immediately prior

=== Open abdomen management ===

* See separate topic


[[Category:Abdo wall and retroperitoneum]]