Medication Summary

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.

Class Summary

Diuretics decrease plasma volume and edema through diuresis.

Furosemide (Lasix)

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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.

Spironolactone (Aldactone)

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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

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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.

Questions

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. [QxMD MEDLINE Link].
Abdominal Compartment Society. Intra-abdominal Hypertension and the Abdominal Compartment Syndrome: Updated Consensus Definitions and Clinical Practice Guidelines from the World Society of the Abdominal Compartment Syndrome. World Society of the Abdominal Compartment Syndrome. Available at http://www.wsacs.org/images/2013%20Guidelines%20slide%20set.pdf. 2013; Accessed: August 29, 2016.
Roberts DJ, Ball CG, Kirkpatrick AW. Increased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome. Curr Opin Crit Care. 2016 Apr. 22 (2):174-85. [QxMD MEDLINE Link].
Newman RK, Dayal N, Dominique E. Abdominal Compartment Syndrome. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Kimball EJ. Intra-abdominal hypertension and abdominal compartment syndrome: a current review. Curr Opin Crit Care. 2021 Apr 1. 27 (2):164-168. [QxMD MEDLINE Link].
De Waele JJ, Kimball E, Malbrain M, Nesbitt I, Cohen J, Kaloiani V, et al. Decompressive laparotomy for abdominal compartment syndrome. Br J Surg. 2016 May. 103 (6):709-715. [QxMD MEDLINE Link]. [Full Text].
Hecker A, Hecker B, Hecker M, Riedel JG, Weigand MA, Padberg W. Acute abdominal compartment syndrome: current diagnostic and therapeutic options. Langenbecks Arch Surg. 2016 Feb. 401 (1):15-24. [QxMD MEDLINE Link].
Rogers WK, Garcia L. Intra-Abdominal Hypertension, Abdominal Compartment Syndrome, and the Open Abdomen. Chest. 2017 Aug 2. [QxMD MEDLINE Link].
Dayal N, Dominique E. Compartment Syndrome, Abdominal. 2017 Jun. [QxMD MEDLINE Link]. [Full Text].
Kirkpatrick AW, Sugrue M, McKee JL, Pereira BM, Roberts DJ, De Waele JJ, et al. Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017. Anaesthesiol Intensive Ther. 2017. 49 (2):83-87. [QxMD MEDLINE Link].
Thabet FC, Ejike JC. Intra-abdominal hypertension and abdominal compartment syndrome in pediatrics. A review. J Crit Care. 2017 Jun 7. 41:275-282. [QxMD MEDLINE Link].
Smit M, Koopman B, Dieperink W, et al. Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU. Ann Intensive Care. 2020 Oct 1. 10 (1):130. [QxMD MEDLINE Link].
Sugrue M, De Waele JJ, De Keulenaer BL, et al. A user's guide to intra-abdominal pressure measurement. Anaesthesiol Intensive Ther. 2015. 47 (3):241-51. [QxMD MEDLINE Link].
Rezeni N, Thabet F. Awareness and management of intra-abdominal hypertension and abdominal compartment syndrome by paediatric intensive care physicians: a national survey. Anaesthesiol Intensive Ther. 2022. 54 (4):315-319. [QxMD MEDLINE Link].
Thabet FC, Bougmiza IM, Chehab MS, et al. Incidence, Risk Factors, and Prognosis of Intra-Abdominal Hypertension in Critically Ill Children: A Prospective Epidemiological Study. J Intensive Care Med. 2016 Jul. 31 (6):403-8. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Bozer J, Rodgers B, Qureshi N, Griffin K, Kenney B. Incidence and Mortality of Pediatric Abdominal Compartment Syndrome. J Surg Res. 2023 Jan 12. 285:59-66. [QxMD MEDLINE Link].
Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984 Jan. 199 (1):28-30. [QxMD MEDLINE Link].
Fietsam R Jr, Villalba M, Glover JL, Clark K. Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg. 1989 Jun. 55 (6):396-402. [QxMD MEDLINE Link].
Bert P. Lessons on the Physiology of Respiration. Paris, France: Paris JP Baillière; 1870.
Marey EJ. Medical Physiology on the Blood Circulation. Paris, France: Paris A Delahaye; 1863. 284–293.
Gross RE. A new method for surgical treatment of large omphaloceles. Surgery. 1948. 24:277–292.
Baggot MG. Abdominal blow-out: A concept. Curr Res Anesth Analg. 1951. 30:295–298.
[Guideline] World Society of the Abdominal Compartment Syndrome. WSACS Consensus Guidelines Summary. The Abdominal Compartment Society. Available at https://www.wsacs.org/education/436/wsacs-consensus-guidelines-summary/. April 7, 2021; Accessed: January 30, 2023.
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. 2016 Apr. 42 (2):207-11. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Strang SG, Van Lieshout EM, Van Waes OJ, Verhofstad MH. Prevalence and mortality of abdominal compartment syndrome in severely injured patients: A systematic review. J Trauma Acute Care Surg. 2016 Sep. 81 (3):585-92. [QxMD MEDLINE Link].
Maluso P, Olson J, Sarani B. Abdominal Compartment Hypertension and Abdominal Compartment Syndrome. Crit Care Clin. 2016 Apr. 32 (2):213-22. [QxMD MEDLINE Link].
Eddy V, Nunn C, Morris JA Jr. Abdominal compartment syndrome. The Nashville experience. Surg Clin North Am. 1997 Aug. 77(4):801-12. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Shaheen AW, Crandall ML, Nicolson NG, Smith-Singares E, Merlotti GJ, Jalundhwala Y, et al. Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes. J Emerg Trauma Shock. 2016 Apr-Jun. 9 (2):53-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Licina A. Acute Abdominal Compartment Syndrome following Extraperitoneal Bladder Perforation. Case Rep Anesthesiol. 2017. 2017:3073160. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Pickhardt PJ, Shimony JS, Heiken JP, et al. The abdominal compartment syndrome: CT findings. AJR Am J Roentgenol. 1999 Sep. 173(3):575-9. [QxMD MEDLINE Link].
Hunt L, Van Luenen H, Alexandrou E, Frost SA, Davidson PM, Hillman K, et al. A comparison of fluid instillation volumes to assess intra-abdominal pressure using Kron's methods. J Trauma Acute Care Surg. 2012 Jul. 73 (1):152-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Prasad GR, Subba Rao JV, Aziz A, Rashmi TM. The Role of Routine Measurement of Intra-abdominal Pressure in Preventing Abdominal Compartment Syndrome. J Indian Assoc Pediatr Surg. 2017 Jul-Sep. 22 (3):134-138. [QxMD MEDLINE Link].
Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am. 1996 Aug. 76(4):833-42. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Păduraru DN, Andronic O, Mușat F, et al. Abdominal Compartment Syndrome-When Is Surgical Decompression Needed?. Diagnostics (Basel). 2021 Dec 7. 11 (12):[QxMD MEDLINE Link].
Ikeda S, Kagami T, Tani S, et al. Decompressive laparotomy for abdominal compartment syndrome resulting from severe acute pancreatitis: a case report. BMC Gastroenterol. 2019 Aug 8. 19 (1):141. [QxMD MEDLINE Link].
Aizawa K, Ohki S, Misawa Y. Open Surgical Decompression Is Useful for the Prevention and Treatment of Abdominal Compartment Syndrome after the Repair of Ruptured Abdominal Aortic and Iliac Artery Aneurysm. Ann Vasc Dis. 2018 Jun 25. 11 (2):196-201. [QxMD MEDLINE Link].
Rubenstein C, Bietz G, Davenport DL, et al. Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2015 Mar. 61 (3):648-54. [QxMD MEDLINE Link].
Nguyen A, Tran C, Malkoc A, Davis V, Neeki MM. Development of Early Abdominal Compartment Syndrome Leading to Emergent Decompressive Laparotomy in Full-Thickness Burn Injury. J Med Cases. 2022 Sep. 13 (9):438-442. [QxMD MEDLINE Link].
Henry R, Ghafil C, Golden A, et al. A Novel Abdominal Decompression Technique to Treat Compartment Syndrome After Burn Injury. J Surg Res. 2021 Apr. 260:448-453. [QxMD MEDLINE Link].
Bouveresse S, Piton G, Badet N, et al. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography. Eur Radiol. 2019 Jul. 29 (7):3839-3846. [QxMD MEDLINE Link].