Define the following terms:
(iii) IPP = MAP – IAP
Decreased cardiac output –
Hypotension – decreased cardiac output.
A slightly less formal discussion of abdominal compartment syndrome takes place in Question 21from the second paper of 2006: "Outline the causes, consequences and the management of abdominal compartment syndrome. "Brief notes on the pathophysiology of abdominal compartment pressure and its measurement are available, with references for the time-rich exam candidate.
First, the definitions. These are derived from a 2011 consensus statement, from which much of the below information is derived.
Specifically, the definitions were copied verbatim from Table 1, "Consensus definitions list"; one might notice that they are identical to the college answer.
Intra-abdominal Hypertension (IAH)
A sustained or repeated pathological elevation in IAP ≥ 12 mmHg
Abdominal Compartment Syndrome (ACS)
A sustained IAP> 20 mmHg (with or without an APP < 60 mmHg) that is associated with new organ dysfunction/failure
Abdominal Perfusion Pressure (APP)
APP = MAP − IAP.
Measurement of intra-abdominal pressure
List the adverse cardiorespiratory effects of an increase in IAP in a mechanically ventilated patient and outline the physiological mechanisms that account for these effects.
The college demands we focus on the cardiorespiratory consequences.
Oh's Intensive Care manual: Chapter 45 (pp. 520) Abdominal surgical catastrophes by Stephen J Streat
Malbrain, Manu LNG, et al. "Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions." Intensive care medicine 32.11 (2006): 1722-1732.
Cheatham, Michael L., et al. "Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension." Journal of Trauma-Injury, Infection, and Critical Care 49.4 (2000): 621-627.
Bailey, Jeffrey, and Marc J. Shapiro. "Abdominal compartment syndrome."Critical Care 4.1 (2000): 23.
Cheatham, Michael Lee. "Abdominal compartment syndrome." Current opinion in critical care 15.2 (2009): 154-162.
Maerz, Linda, and Lewis J. Kaplan. "Abdominal compartment syndrome."Critical care medicine 36.4 (2008): S212-S215.
Saggi, Bob H., et al. "Abdominal compartment syndrome." Journal of Trauma-Injury, Infection, and Critical Care 45.3 (1998): 597-609.