Recognition and management of abdominal compartment syndrome in the United Kingdom

Abdominal compartment syndrome(ACS) is a condition associated with high mortality if undiagnosed and untreated. ACS is seen in patients managed in intensive care units. Very little is known on the causes, diagnosis and treatment of this condition in the United Kingdom. Questionnaire study. 222 intensive care units in the UK dealing with acute abdominal condition. 127 (57.2%) questionnaires were returned (32 from teaching hospitals and 95 from district general hospitals. Among these, 96.9% of teaching hospitals and 72.6% of district general hospitals had seen cases of ACS. The conditions most frequently associated with ACS were small and large bowel surgery (67%), vascular surgery (62%) and trauma (60%). ACS was suspected mainly when there was a distended abdomen (98.6%), oliguria (94.5%) and increased ventilatory support (72.2%). The diagnosis was confirmed either clinically (68.4%) or by measuring intra-abdominal pressure (83.7%). The commonest method for measuring intra-abdominal pressure was the intra-vesical route. The pressure threshold for diagnosing the condition was variable, with a range of 11-50 mmHg. There was a large variation in the number of patients who were decompressed. Fewer patients are diagnosed with ACS in district general hospitals compared with teaching hospitals. The threshold for the diagnosis of ACS is variable in the UK, as were the numbers of patients who were decompressed, suggesting that many doctors are still reluctant to accept this condition. This study would suggest that there is a need for standardisation of diagnostic threshold and protocols regarding decompression in ACS.