Abdominelles Kompartmentsyndrom

Zusammenfassung

Das abdominelle Kompartmentsyndrom (ACS) ist ein lebensbedrohliches Krankheitsbild, dessen Behandlungserfolg insbesondere von einer zeitnahen zielführenden Diagnostik und adäquaten Behandlungsprinzipien abhängt. Dieser CME-Beitrag beschreibt die pathophysiologischen Vorgänge beim ACS sowie das diagnostische und therapeutische Vorgehen bei diesen schwerst gefährdeten, intensivpflichtigen Patienten.

Abstract

Intra-abdominal hypertension and acute abdominal compartment syndrome are complex diseases that have a high morbidity and mortality and must be treated on an interdisciplinary basis in an intensive care unit. In order to be able to recognize and treat an ACS in good time, the intra-abdominal pressure should be measured every 4 – 6 hours in seriously ill patients with risk factors for an ACS. The measurement of the bladder pressure has proven to be valid and meaningful. The most effective method of pressure relief is the complete median laparotomy. Before surgical intervention, all conservative measures should be exhausted, since surgical decompression also has a high mortality and morbidity. Different approaches have been described for dealing with the open abdomen. Today, best experiences have been made with continuous negative pressure dressings and stepwise closure of the abdomen. After the abdomen is closed, complex incisional hernias occur, which require extensive surgeries to repair. Despite well-developed conservative and surgical methods of treating IAH and ACS, mortality and morbidity remain high.

Schlüsselwörter

intraabdomineller Hochdruck - abdominelles Kompartmentsyndrom - Diagnostik - Therapie

Key words

intra-abdominal hypertension, acute abdominal compartment syndrome, diagnostics, therapy

• Literatur

• 1 Malbrain ML, Chiumello D, Pelosi P. et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: A multicenter epidemiological study. Crit Care Med 2005; 33: 315-322
• 2 Gestring M. Abdominal compartment in adults. UpToDate 2021. Im Internet (Stand: 16.04.2021): https://www.uptodate.com/contents/abdominal-compartment-syndrome-in-adults
• 3 Kirkpatrick AW, Roberts DJ, De Waele J. et al. Intra-abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013; 39: 1190-1206
• 4 Lu K, Ni H, Sun J. et al. Risk factors and outcome of intra-abdominal Hypertension in patients with severe acute pancreatitis. World J Surg 2012; 36: 171-178
• 5 Padar M, Blaser AR, Talving P. et al. Abdominal Compartment Syndrome: Improving outcomes with a multidisciplinary appproch – A narrative review. J Multidiscip Healthc 2019; 12: 1061-1074
• 6 Smit M, Koopman B, Dieperink W. et al. Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to ICU. Intensive Care 2020; 10: 130
• 7 Scheppach W. Abdominal compartment syndrome. Best Pract Res Clin Gastroenterol 2009; 23: 25-33
• 8 Malbrain ML, Cheatham ML, Kirkpatrick A. et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006; 32: 1722-1732
• 9 Sanchez NC, Tenofsky PL, Dort JM. et al. What is normal intra-abdominal pressure?. Am Surg 2001; 67: 243-248
• 10 Kirkpatrick AW, Brenneman FD, McLean RF. et al. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients?. Can J Surg 2000; 43: 207-211
• 11 Caldwell CB, Ricota JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 1987; 43: 14-20
• 12 Schein M, Ivatury R. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 1998; 85: 1027-1028
• 13 Coccolini F, Roberts D, Ansaloni L. et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg 2018; 13: 7
• 14 Vidal MG, Ruiz Weisser J, Gonzales F. et al. Incidence and clinical efforts of intra-abdominal hypertension in critical ill patients. Crit Care Med 2008; 36: 1823-1831
• 15 Sugrue M, De Waele JJ, De Keulenear BL. et al. A userʼs guide to intra-abdominal pressure measurement. Anaesthesiol Intensive Ther 2020; 47: 241-251
• 16 De Waele JJ, Hoste E, Malbrain ML. Decompressive laparotomy for abdominal compartment syndrome – a critical analysis. Crit Care 2006; 10: R51
• 17 Holodinsky JK, Roberts DJ, Ball CG. et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care 2018; 17: R249
• 18 Sugrue M, Bauman A, Jones F. et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 2002; 26: 1428-1431
• 19 von Delius S, Huber W, Schmid RM. Messung des intraabdominellen Drucks. Intensivmed 2010; 47: 392-401
• 20 Van Damme L, De Waele JJ. Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review a meta-analysis. Crit Care 2018; 22: 179
• 21 De Waele JJ, De Laet I, Malbrain ML. Understandig abdominal compartment syndrome. Intensive Care Med 2016; 42: 1068-1070
• 22 Starkopf J, Reintam Blaser A, Malbrain ML. et al. Intra-abdominal hypertension and abdominal compartment syndrome (IAH/ACS). Part of European Society of Intensive Care Medicine eModule “The abdomen in critical care”; 2017. Im Internet (Stand: 16.04.2021): https://collaboration.esicm.org/The+abdomen+in+critical+care
• 23 De Waele JJ, Kimball E, Malbrain ML. et al. Decompressive laparotomy for abdominal compartment syndrome. Br J Surg 2016; 103: 709-715
• 24 Mentula P, Hienonen P, Kemppainen E. et al. Surgical decompression for abdominal compartment syndrome on severe acute pancreatitis. Arch Surg 2010; 145: 764-769
• 25 Chiara O, Cimbanassi S, Biffl W. et al. International consensus conference on open abdomen in trauma. J Trauma Acute Care Surg 2016; 80: 173-183
• 26 Björck M, Wanhainen A. Management of abdominal compartment syndrome and the open abdomen. Eur J Vasc Endovasc Surg 2014; 47: 279-287
• 27 Kubiak BD, Albert SP, Gatto LA. et al. Peritoneal negative pressure therapy prevents multiple organ injury in a chronic porcine sepsis and ischaemia/reperfusions model. Shock 2010; 34: 525-534
• 28 Seternes A, Rekstad LC, Mo S. et al. Open abdomen treated with negative pressure wound therapy: indiactions, management and survival. World J Surg 2017; 41: 152-161
• 29 Tolonen M, Metula P, Sallinen V. et al. Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: a single-center 8-year experience. J Trauma Acute Care Surg 2017; 82: 1100-1105
• 30 Burger JW, Luijendijk RW, Hop WC. et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004; 240: 578-583
• 31 Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am 2013; 93: 1111-1133
• 32 Satterwhite TS, Miri S, Chung C. et al. Outcomes of complex abdominal herniorraphy: experience with 106 cases. Am Plast Surg 2012; 68: 382-388
• 33 Cothren CC, Moore EE, Johnsen JL. et al. One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg 2006; 192: 238-242
• 34 Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 1992; 33: 45-48