Decompression in abdominal compartment syndrome: How early is early?

Excerpt

Intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are well-recognized pathological entities that frequently occur in critically ill patients and that indicate a worsening of the prognosis, although there is still a lack of awareness beyond physicians with regard to this problem [1, 2]. In principle, a wide consensus exists with regard to the need for intra-abdominal pressure monitoring as a diagnostic tool, and of surgical abdominal decompression as a therapeutic approach. Nevertheless, the adequate timing for decompression laparotomy remains a matter for discussion, and this aspect has already been emphasized by Sugrue and colleagues showing that surgical decompression failed to reverse renal failure in a wide majority of ICU patients [3]. Not only is timing important but also technique, as De Waele and colleagues in a review of 250 patients undergoing decompression found that IAH persisted in the majority [4]. In addition, they noted a significant delay to decompression of between 12 and 38 h. …