Postinjury abdominal compartment syndrome: from recognition to prevention

Lancet. 2014 Oct 18;384(9952):1466-75. doi: 10.1016/S0140-6736(14)61689-5. Epub 2014 Oct 17.

Abstract

Postinjury abdominal compartment syndrome (ACS) is an example of a deadly clinical occurrence that was eliminated by strategic research and focused preventions. In the 1990s, the syndrome emerged with the widespread use of damage control surgery and aggressive crystalloid-based resuscitation. Patients who previously exsanguinated on the operating table made it to intensive care units, but then developed highly lethal hyperacute respiratory, renal, and cardiac failure due to increased abdominal pressure. Among many factors, delayed haemorrhage control and preload driven excessive use of crystalloid resuscitation were identified as modifiable predictors. The surrogate effect of preventive strategies, including the challenge of the 40-year-old standard of large volume crystalloid resuscitation for traumatic shock, greatly reduced cases of ACS. The discoveries were rapidly translated to civilian and military trauma surgical practices and fundamentally changed the way trauma patients are resuscitated today with substantially improved outcomes.

Publication types

  • Review

MeSH terms

  • Fluid Therapy / adverse effects
  • Humans
  • Intra-Abdominal Hypertension / diagnosis
  • Intra-Abdominal Hypertension / etiology*
  • Intra-Abdominal Hypertension / physiopathology
  • Intra-Abdominal Hypertension / prevention & control
  • Postoperative Complications / diagnosis
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control
  • Traumatology / trends
  • Wounds and Injuries / complications*
  • Wounds and Injuries / surgery