IBCC Episode 28 - Abdominal Compartment Syndrome

Abdominal compartment syndrome represents a critical, often overlooked cause of multi-organ failure in intensive care settings. Distinguishing between primary pathology and secondary systemic inflammation driven by fluid overload is essential for diagnosis. Physical exams lack sensitivity, necessitating objective measurement of intra-abdominal pressure via Foley catheter, ideally targeting an abdominal perfusion pressure—calculated as mean arterial pressure minus intra-abdominal pressure—above 60 mmHg. Management prioritizes conservative measures, including fluid restriction, diuresis, and luminal decompression, rather than immediate surgical intervention. Clinicians must exercise caution during intubation, as positive pressure ventilation can exacerbate abdominal pressure, and recognize that a collapsed inferior vena cava in this context does not warrant further fluid resuscitation. Proactive prevention through fluid-conservative strategies remains the most effective approach to mitigating the incidence of this potentially life-threatening condition.