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Acute Spontaneous Peritonitis; intra-abdominal abscess; ileus; intestinal obstruction; ruptured abdominal aortic aneurysm; tension pneumoperitoneum; acute pancreatitis; mesenteric venous thrombosis Postoperative Postoperative peritonitis; intra-abdominal abscess; ileus; acute gastric dilatation; intraperitoneal hemorrhage (coagulopathy) Post-traumatic Intraperitoneal, retroperitoneal bleeding; postresuscitation visceral edema (including hypothermia, septic shock, and cardiac arrest) Iatrogenic Laparoscopic procedures; pneumatic antishock garment; abdominal packing; reduction of a massive parietal or diaphragmatic hernia; abdominal closure under excessive tension (edema of bowel and/or retroperitoneum) Chronic Ascites; large abdominal tumor; chronic ambulatory peritoneal dialysis; pregnancy Adapted from Schein M et al. J Am Coll Surg. 1995.[27]
Change ACS Sepsis Cardiovascular Venous return (preload) Decreased Decreased Central venous pressure Increased (artificial) Decreased Pulmonary capillary wedge pressure Increased (artificial) Increased Systemic vascular resistance Increased Increased or - Volume responsive Increased Increased Pulmonary Resistance Increased Increased Compliance Decreased Decreased Hypoxemia + + Renal Oliguria + (common) + Anuria + - (rare) Volume (perfusion) responsive - + -, absent or no change; +, present.
Clinical presentation
- Progressive oliguria despite adequate perfusion
- Hypoxia with increasing airway pressures
- Tense or massively distended abdomen
- Intra-abdominal pressures > 15 mm Hg
- Refractory metabolic acidosis
Situations requiring a high index of suspicion
- Following abdominal surgery for trauma or ruptured abdominal aortic aneurysm
- Damage control surgery with intra-abdominal packing
- Resuscitation for shock of any cause (including sepsis)
- Intra-abdominal infections (peritonitis, abscess)