الفهرس 
Causes of intra-abdominal hypertensionOnly 14 pages are availabe for public view
 |  | from | 159 |  |  |
| | | from | 159 | | |
Abstract
ACS is a real entity. The detrimental effects of elevated IAP and the methods and benefits of its decompression have been well studied, both in the laboratory and in clinical practice. Diagnostic suspicion may be confirmed with objective measurements of IAP to select patients who may benefit from ”leaving the abdomen open” with a fascial prosthesis such as the artificial burr.
ACS impairs physiology and requires treatment It occurs more commonly with acute than with chronic IAH. Functional impairments involve (a) the cardiovascular system; (b) the respiratory system; (c) hepatic, renal, and gastrointestinal function; and (d) intracranial pressure. IAH decreases venous return, increases systemic vascular resistance as well as intrathoracic pressure, and, therefore, reduces cardiac output. It also adversely affects cardiovascular monitoring. In the presence of increased abdominal pressure, atelectasis and pneumonia are likely to develop, and impaired ventilation may lead to respiratory failure.
Also, blood flow to the liver and kidneys may be reduced, resulting in functional impairment of both organs. The adverse effects on gastrointestinal function result from impairing lymphatic, venous, and arterial flow. Anastomotic healing may become a problem under these circumstances. The correlation of increased intracranial pressure and IAP may be a problem for trauma patients with simultaneous injuries to the head and abdomen.
Operative decompression is always indicated. The gap between the abdominal wound edges must, be temporarily covered to prevent fascia retraction and formation of huge hernias.
Operative decompression is achieved by abdominal fasciotomy and covering the fascial gap with mesh made of Marlex or Gore-Tex, silastic, or by a fascial prosthesis (artificial burr). All meshes help to decompress the abdomen. The artificial burr offers further advantages by permitting successive reapproximation of the fascia until final fascial closure and by avoiding the fistula and hernia formation seen with the other meshes.
Perioperative anesthetic management of decompressive laparotomy is challenging as it ensues problems such as bleeding, hypothermia and metabolic acidosis.
Postoperative ICU care is mandatory and directly affects the outcome; it includes correction of coagulopathy, hypothermia and metabolic acidosis.