Analyzing the Clinical Outcomes, and Timely Interventions for Abdominal Compartment Syndrome among High Risk Individuals in a Tertiary Care Hospital in India

INTRODUCTION: Abdominal compartment syndrome is one which pressure increases in a confined anatomical space and affects its function and viability of the tissue. In abdominal hypertension there is increase in volume in its contents IAP impair physiology and organ function, because of the limited compliance of abdominal wall. This study is being undertaken to evaluate the impact of IAP on outcome in patients undergoing laparotomies. AIMS AND OBJECTIVES: A Prospective analysis to identify the 1. Incidence of; a. Intra Abdominal Hypertension (IAH), b. Abdominal Compartment Syndrome (ACS), 2. Etiology, 3. Effects on morbidity to the patient, 4. Timely medical and surgical interventions made among high risk patients in a tertiary care hospital in Coimbatore, India. MATERIALS AND METHODS: The detailed case history of two hundred and thirteen cases was recorded, clinical examination and investigations carried out. Patients undergoing elective and emergency laparotomies were allotted under Group A and Group B respectively. Intra- Abdominal pressure was monitored daily till the IAP normalized or till post operative day 7 along with the pulse, blood pressure, respiratory rate, oxygen saturation, abdominal girth, urine output and arterial blood gas in patients who underwent a laparotomy. All these factors were used to monitor the progress and assess the recovery of the patient. Inclusion Criteria: • All patients being planned for emergency and elective laparotomies. Exclusion Criteria: • Cases of Abdominal trauma. • Patients with pre-existing renal and hepatic derangement. OBSERVATIONS AND RESULTS: Of the 100 cases in the study, 66.2% of the patients were male and majority of the patients (59.15%) were in the age group of 21-50 years. 65.26% of the cases were emergency procedures. The incidence of IAH in the current study was 36.16% with 20.66% having mild IAH, 11.27% having moderate IAH and 4.23% having severe IAH. There was significant association between PR, MAP, RR, U/O, A/G, SpO2 and the IAP. However BMI did not show a high degree of association with IAP. There was also significant association between the IAP and Liver and Renal function tests. The mean IAP is significantly higher in the emergency surgery group as compared to the elective surgery group. There was a very high complication rate of 66.67% and 88.89% associated with Grade III and IV of IAP respectively. The single death in the study were associated with IAP of Grade IV which had a mortality rate of 50%. CONCLUSIONS: There was significant association between Pulse rate, Mean arterial pressure, Respiratory rate, Urine output, Body mass index, Abdominal girth, Oxygen saturation and the Intra abdominal pressure. There was significant association between Total leucocyte count, Liver function tests, Renal function tests and intra abdominal pressure. Patients with Grade III and IV Intra abdominal hypertension were associated with a higher rate of morbidity and mortality. There was no significant association between intra abdominal pressure and co-morbidities like Diabetes Mellitus and Hypertension. Incidence of intra abdominal hypertension was higher in emergency laparotomies as compared to elective laparotomies.