Abdominal Compartment Syndrome Medication
- Author: Richard Paula, MD; Chief Editor: Trevor John Mills, MD, MPH more...
The goal of pharmacotherapy is to reduce intra-abdominal pressure. Diuretics are used for this purpose. However, pharmacologic therapy is less effective than mechanical drainage.
Diuretics decrease plasma volume and edema through diuresis.
Furosemide increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. The dose must be individualized. Depending on response, administer at increments of 20-40 mg no sooner than 6-8 h after previous dose, until desired diuresis occurs. When treating infants, titrate with 1-mg/kg/dose increments until satisfactory effect is achieved.
This agent is used for management of edema resulting from excessive aldosterone excretion. It competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions.
Amiloride is a pyrazine-carbonyl-guanidine unrelated chemically to other known antikaliuretic or diuretic agents. It is a potassium-conserving (antikaliuretic) drug that, compared with thiazide diuretics, possesses weak natriuretic, diuretic, and antihypertensive activity.
Simon RJ, Friedlander MH, Ivatury RR, et al. Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma. 1997 Mar. 42(3):398-403; discussion 404-5. [Medline].
De Waele JJ, Ejike JC, Leppäniemi A, De Keulenaer BL, De Laet I, Kirkpatrick AW, et al. Intra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma. Anaesthesiol Intensive Ther. 2015. 47 (3):219-27. [Medline].
Rubenstein C, Bietz G, Davenport DL, Winkler M, Endean ED. Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2015 Mar. 61 (3):648-54. [Medline].
Karkos CD, Menexes GC, Patelis N, Kalogirou TE, Giagtzidis IT, Harkin DW. A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2014 Mar. 59(3):829-42. [Medline].
Malbrain ML, De Keulenaer BL, Oda J, De Laet I, De Waele JJ, Roberts DJ, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine. Anaesthesiol Intensive Ther. 2015. 47 (3):228-40. [Medline].
Hobson KG, Young KM, Ciraulo A. Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma. 2002 Dec. 53(6):1129-33; discussion 1133-4. [Medline].
Harrell BR, Melander S. Identifying the association among risk factors and mortality in trauma patients with intra-abdominal hypertension and abdominal compartment syndrome. J Trauma Nurs. 2012 Jul-Sep. 19(3):182-9. [Medline].
Macedo FI, Sciarretta JD, Otero CA, Ruiz G, Ebler DJ, Pizano LR, et al. Secondary abdominal compartment syndrome after complicated traumatic lower extremity vascular injuries. Eur J Trauma Emerg Surg. 2015 Apr 8. [Medline].
Eddy V, Nunn C, Morris JA Jr. Abdominal compartment syndrome. The Nashville experience. Surg Clin North Am. 1997 Aug. 77(4):801-12. [Medline].
Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005 Feb. 33(2):315-22. [Medline].
Ivatury RR, Diebel L, Porter JM, Simon RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am. 1997 Aug. 77(4):783-800. [Medline].
Pickhardt PJ, Shimony JS, Heiken JP, et al. The abdominal compartment syndrome: CT findings. AJR Am J Roentgenol. 1999 Sep. 173(3):575-9. [Medline].
Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am. 1996 Aug. 76(4):833-42. [Medline].
Cheatham ML, White MW, Sagraves SG, et al. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma. 2000 Oct. 49(4):621-6; discussion 626-7. [Medline].
Madigan MC, Kemp CD, Johnson JC, Cotton BA. Secondary abdominal compartment syndrome after severe extremity injury: are early, aggressive fluid resuscitation strategies to blame?. J Trauma. 2008 Feb. 64(2):280-5. [Medline].
Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival?. Crit Care Med. 2010 Feb. 38(2):402-7. [Medline].
Chen RJ, Fang JF, Lin BC, Kao JL. Laparoscopic decompression of abdominal compartment syndrome after blunt hepatic trauma. Surg Endosc. 2000 Oct. 14(10):966. [Medline].
Regli A, De Keulenaer B, De Laet I, Roberts D, Dabrowski W, Malbrain ML. Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension. Anaesthesiol Intensive Ther. 2015. 47 (1):45-53. [Medline].
World Society of the Abdominal Compartment Syndrome. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul. 39 (7):1190-206. [Medline].
Agusti M, Elizalde JI, Adalia R. Dobutamine restores intestinal mucosal blood flow in a porcine model of intra-abdominal hyperpressure. Crit Care Med. 2000 Feb. 28(2):467-72. [Medline].
O'Mara MS, Slater H, Goldfarb IW, Caushaj PF. A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma. 2005 May. 58(5):1011-8. [Medline].
Oda J, Ueyama M, Yamashita K, Inoue T, Noborio M, Ode Y. Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. J Trauma. 2006 Jan. 60(1):64-71. [Medline].