Das abdominale Kompartmentsyndrom – Relevanz und therapeutische Konsequenzen

Zusammenfassung

Hintergrund: Die intraabdominale Hypertension (IAH) hat eine hohe Prävalenz bei Intensivpatienten. Sie wird zunehmend als Risikofaktor für schlechtes Outcome wahrgenommen. Patienten / Material und Methoden: Review der vorliegenden Literatur mit Angabe konkreter Handlungsvorschläge. Definitionen, einheitliche Messmethoden des intraabdominellen Druckes (IAP) und Therapieoptionen von konservativ bis zur Dekompressionslaparotomie werden erörtert. Ergebnisse: Das Abdominale Kompartmentsyndrom (ACS) ist definiert als IAH mit einem an­haltenden Druck über 20 mmHg in Verbindung mit neu aufgetretenem Organversagen. Es tritt insbesondere bei chirurgischen Intensivpatienten auf und ist mit einer schlechten Prognose verknüpft. Die mit IAH assoziierten Funktionsstö­rungen betreffen vor allem Niere und Lunge. Der Pathomechanismus ist im Wesentlichen die ­intra­abdominelle Perfusionsstörung. Der klinische Eindruck allein erlaubt keine valide Abschätzung des intraabdominellen Druckes. Schlussfolgerung: Bei klinischen Risikopatienten sollte der IAP auch prophylaktisch gemessen werden. Bei IAH müssen konservative Maßnahmen zur Senkung ergriffen werden, bei ausbleibendem Erfolg muss die Dekompressionslaparotomie erwogen werden. 

Abstract

Background: Intra-abdominal hypertension (IAH) has a high prevalence among critically ill patients. It is increasingly recognised as a risk factor for poor outcome. Patients / Material and Methods: A review of the literature including explicit management instructions was performed. We report the standardised techniques for intra-abdominal pressure (IAP) measurement as well as consensus definitions and treatment recommendations ranging from conservative measures to decompression laparotomy. Results: The abdominal compartment syndrome (ACS) is defined as a sustained IAH > 20 mmHg accompanied by new organ dysfunctions. It occurs predominantly in surgical patients and is asso­ciat­ed with a poor outcome. Organ dysfunctions related to IAH mainly concern the kidneys and ­respiratory system. The mechanism of action essentially is a perfusion deficit. Clinical judgement alone does not allow a valid estimate of intra-abdominal pressure. Conclusion: In patients at risk the IAP should be measured. In case of IAH conservative options for lowering the pressure are mandatory. Decompression laparotomy should be considered if conservative measures fail. 

Schlüsselwörter

abdominelles Kompartmentsyndrom - Abdominalchirurgie - Intensivmedizin - Laparostoma - Peritonitis - Sepsis

Key words

abdominal compartment syndrome - abdominal surgery - intensive care medicine - laparostoma - peritonitis - sepsis

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