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  • Abdominal compartment syndrome (ACS) is defined as a sustained intra-abdominal pressure > 20 mm Hg associated with a new organ dysfunction or failure.

  • Primary ACS occurs due to injuries or diseases in the abdominopelvic region and is the most common form of ACS. Examples include intra-abdominal hemorrhage, pancreatitis, and bowel ischemia or perforation.

  • Secondary ACS occurs due to a problem outside of the abdomen. Examples include diffuse capillary leak secondary to sepsis, burns, ischemia-reperfusion, or following massive fluid resuscitation.

  • Recurrent (tertiary) ACS is ACS which recurs following treatment.

  • ACS produces organ dysfunction of one or more organ systems including respiratory, cardiovascular, gastrointestinal, renal, hepatic, and CNS.

  • ACS can complicate bedside assessment of intravascular volume as it increases central venous pressures, flattens the IVC, and reduces urine output.

  • Untreated, ACS has a high mortality and thus, the diagnosis must be considered in all patients with risk factors or a new organ dysfunction.

  • Diagnosis of ACS is confirmed by measuring bladder pressure.

  • High-risk patients should have bladder pressures monitored.

  • Management of ACS depends on severity and cause, and ranges from medical management (e.g., sedation, fluid restriction/removal, gastric or colonic decompression) to surgery (abdominal decompression ± surgical management of inciting pathology).


Abdominal compartment syndrome (ACS) is a life-threatening condition caused by elevated intra-abdominal pressure (IAP) leading to organ dysfunction.1 Observational studies demonstrate a high incidence of intra-abdominal hypertension (defined as a sustained or repeated pathological elevation in IAP greater ≥ 12 mm Hg) and ACS in ICU patients.2 ACS is easy to miss in critically ill patients and therefore a high degree of suspicion is warranted.3 Identification of high-risk patients is essential and routine measurement of IAP in high-risk patients is recommended.4 Management strategies depend on the degree of IAP, the rate of increase of IAP, and the severity of organ dysfunction.5 If left untreated, ACS can progress to multisystem organ failure and death.


The abdomen is bordered by both rigid (costal margins, spine, and pelvis) and flexible walls (diaphragm, abdominal musculature, and fascia).1 Intra-abdominal pressure (IAP) is defined as the steady-state pressure within the abdominal cavity, influenced by both the volume of contents and the wall of the abdomen.4 The average IAP in hospitalized patients is 6.5 mm Hg, whereas the average IAP in critically ill patients is higher—between 12 and 16 mm Hg.6,7

As IAP increases, the perfusion of abdominal organs becomes impaired. Analogous to other body compartments, abdominal organ perfusion is determined by the abdominal perfusion pressure (APP), which is defined as mean arterial pressure minus IAP. Below an APP of 60 mm Hg, perfusion to abdominal viscera is compromised.

Intra-abdominal hypertension (IAH) is defined as a sustained or repeated pathological elevation in IAP ≥ 12 mm Hg.4 IAH is associated ...

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