Abdominal Acillerde Karın İçi Basınç Ölçümü ve İntraabdominal Hipertansiyon
Özet
İntraabdominal hipertansiyon (İAH) ve abdominal kompartman sendromu (AKS), acil servislerde resüsitasyona dirençli şok tablolarının altında yatan ve sıklıkla gözden kaçan sistemik patolojilerdir. Karın içi basınç artışı; abdominal perfüzyon basıncını düşürerek, kardiyovasküler, pulmoner, renal ve serebral sistemlerde domino etkisiyle multiorgan yetmezliğini tetiklemektedir. Klinik muayene tanı koymada yetersiz kaldığında, risk grubundaki hastalarda altın standart olan intravezikal basınç ölçümü hayati önem taşır. Yönetim süreci; intralüminal dekompresyon, abdominal kompliyansın artırılması ve negatif sıvı dengesinin sağlanması gibi medikal basamaklarla başlasa da, dirençli olgularda cerrahi dekompresyon tek kesin çözüm yoludur. Erken farkındalık ve protokollü izlem, bu "sessiz katil"e bağlı mortaliteyi azaltmanın temel anahtarıdır.
Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are often overlooked systemic pathologies underlying resuscitation-resistant shock presentations in emergency departments. Increased intra-abdominal pressure reduces abdominal perfusion pressure, triggering multi-organ failure through a domino effect in the cardiovascular, pulmonary, renal, and cerebral systems. When clinical examination is insufficient for diagnosis, intravesical pressure measurement, the gold standard in at-risk patients, is of vital importance. Although the management process begins with medical steps such as intraluminal decompression, increasing abdominal compliance, and achieving negative fluid balance, surgical decompression is the only definitive solution in resistant cases. Early detection and structured monitoring are key to reducing mortality associated with this "silent killer".
Referanslar
Jacobs R, Wise RD, Myatchin I, et al. Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review. Life. 2022 Sep 6;12(9):1390.
Reintam Blaser A, Preiser JC, Fruhwald S, et al. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Critical care, 2020, 24.1: 224.
Kirkpatrick AW, Sugrue M, McKee JL, et al. Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017. Anaesthesiol Intensive Ther. 2017 Jun 22;49(2):83–7.
Li Z, Lu F, Wu J, et al. Awareness, knowledge and practices related to intra-abdominal hypertension and abdominal compartment syndrome among intensive care providers: a systematic scoping review. Ann Intensive Care. 2025 Jul 24;15(1):106.
Smit M, Van Meurs M, Zijlstra JG. Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps. Scand J Surg. 2022 Mar;111(1):14574969211030128.
Khanna AK, Minear S, Kurz A, et al. Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry. J Clin Monit Comput. 2023 Feb;37(1):189–99.
Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul;39(7):1190–206.
Kinoshita S, Hara C, Matsumoto Y, et al. Impact of abdominal compliance on surgical stress and postoperative recovery in laparoscopic groin hernia repair: a retrospective cohort study. Hernia. 2024 Dec 3;29(1):40.
Novak J, Jacisko J, Busch A, et al. Intra-abdominal pressure correlates with abdominal wall tension during clinical evaluation tests. Clinical Biomechanics. 2021 Aug;88:105426.
Khanna AK, Rola P, Malbrain MLNG. Biomarkers for intra-abdominal pressure: another tool in the toolbox? European Heart Journal Acute Cardiovascular Care. 2022 Jun 22;11(6):461–3.
Xu L, Zhao W, He J, et al. Abdominal perfusion pressure is critical for survival analysis in patients with intra-abdominal hypertension: mortality prediction using incomplete data. International Journal of Surgery. 2025 Jan;111(1):371–81.
Jiang R, Ma H, Song X, et al. Increased intra-abdominal pressure linked to worse long-term prognosis among patients with orthotopic liver transplantation: a retrospective, observational study. BMC Gastroenterol. 2025 Mar 28;25(1):204.
Zarnescu NO, Dumitrascu I, Zarnescu EC, et al. Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review. Diagnostics. 2022 Dec 20;13(1):1.
Mancilla Asencio C, Berger Fleiszig Z. Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis. Medicina. 2022 Jun 10;58(6):785.
Gardner AK, Schroeder EL. Pathophysiology of intraabdominal hypertension and abdominal compartment syndrome and relevance to veterinary critical care. J Vet Emergen Crit Care. 2022 Jan;32(S1):48–56.
Nasa P, Wise RD, Smit M, et al. International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome. World J Emerg Surg. 2024 Nov 29;19(1):39.
Malbrain MLNG. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Medicine. 2004 Mar 1;30(3):357–71.
Kaussen T, Gutting M, Lasch F, et al. Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study. ICMx. 2021 Dec;9(1):24.
Li Z, Wang H, Lu F. The development, feasibility and credibility of intra-abdominal pressure measurement techniques: A scoping review. Yan F, editor. PLoS ONE. 2024 Mar 21;19(3):e0297982.
Pereira BM, Dorigatti AE, Melek MZ, et al. Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome – a preliminary analysis. Anaesthesiol Intensive Ther. 2019 Oct 16;51(5):370–2.
Iyer D, Rastogi P, Åneman A, et al. Early screening to identify patients at risk of developing intra‐abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand. 2014 Nov;58(10):1267–75.
Smith S, Priestap F, Parry N, et al. Intraabdominal hypertension is less common than it used to be: A pilot step wedge trial. The Journal of Critical Care Medicine. 2025 Jan 1;11(1):95–100.
Gardner AK, Schroeder EL. Pathophysiology of intraabdominal hypertension and abdominal compartment syndrome and relevance to veterinary critical care. J Vet Emergen Crit Care. 2022 Jan;32(S1):48–56.
Dabrowski W, Rola P, Malbrain MLNG. Intra-abdominal pressure monitoring in cardiac surgery: is this the canary in the coalmine for kidney injury? J Clin Monit Comput. 2023 Apr;37(2):351–8.
Regli A, Reintam Blaser A, De Keulenaer B, et al. Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome – A sub-analysis of a prospective cohort. Journal of Critical Care. 2021 Aug;64:165–72.
Nasa P, Wise RD, Smit M, et al. International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome. World J Emerg Surg. 2024 Nov 29;19(1):39.
Perova-Sharonova VM, Albokrinov AA, Fesenko UA, et al. Effect of intraabdominal hypertension on splanchnic blood flow in children with appendicular peritonitis. Journal of Anaesthesiology Clinical Pharmacology. 2021 Jul;37(3):360–5.
Mohan S, Lim ZY, Chan KS, et al. Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome. Life. 2023 Jan 24;13(2):330.
Jayasundara S, Goonewardene M, Dassanayake L. The association between maternal intra-abdominal pressure and hypertension in pregnancy. Jayakody S, editor. PLoS ONE. 2023 Oct 18;18(10):e0284230.
Referanslar
Jacobs R, Wise RD, Myatchin I, et al. Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review. Life. 2022 Sep 6;12(9):1390.
Reintam Blaser A, Preiser JC, Fruhwald S, et al. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Critical care, 2020, 24.1: 224.
Kirkpatrick AW, Sugrue M, McKee JL, et al. Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017. Anaesthesiol Intensive Ther. 2017 Jun 22;49(2):83–7.
Li Z, Lu F, Wu J, et al. Awareness, knowledge and practices related to intra-abdominal hypertension and abdominal compartment syndrome among intensive care providers: a systematic scoping review. Ann Intensive Care. 2025 Jul 24;15(1):106.
Smit M, Van Meurs M, Zijlstra JG. Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps. Scand J Surg. 2022 Mar;111(1):14574969211030128.
Khanna AK, Minear S, Kurz A, et al. Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry. J Clin Monit Comput. 2023 Feb;37(1):189–99.
Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul;39(7):1190–206.
Kinoshita S, Hara C, Matsumoto Y, et al. Impact of abdominal compliance on surgical stress and postoperative recovery in laparoscopic groin hernia repair: a retrospective cohort study. Hernia. 2024 Dec 3;29(1):40.
Novak J, Jacisko J, Busch A, et al. Intra-abdominal pressure correlates with abdominal wall tension during clinical evaluation tests. Clinical Biomechanics. 2021 Aug;88:105426.
Khanna AK, Rola P, Malbrain MLNG. Biomarkers for intra-abdominal pressure: another tool in the toolbox? European Heart Journal Acute Cardiovascular Care. 2022 Jun 22;11(6):461–3.
Xu L, Zhao W, He J, et al. Abdominal perfusion pressure is critical for survival analysis in patients with intra-abdominal hypertension: mortality prediction using incomplete data. International Journal of Surgery. 2025 Jan;111(1):371–81.
Jiang R, Ma H, Song X, et al. Increased intra-abdominal pressure linked to worse long-term prognosis among patients with orthotopic liver transplantation: a retrospective, observational study. BMC Gastroenterol. 2025 Mar 28;25(1):204.
Zarnescu NO, Dumitrascu I, Zarnescu EC, et al. Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review. Diagnostics. 2022 Dec 20;13(1):1.
Mancilla Asencio C, Berger Fleiszig Z. Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis. Medicina. 2022 Jun 10;58(6):785.
Gardner AK, Schroeder EL. Pathophysiology of intraabdominal hypertension and abdominal compartment syndrome and relevance to veterinary critical care. J Vet Emergen Crit Care. 2022 Jan;32(S1):48–56.
Nasa P, Wise RD, Smit M, et al. International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome. World J Emerg Surg. 2024 Nov 29;19(1):39.
Malbrain MLNG. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Medicine. 2004 Mar 1;30(3):357–71.
Kaussen T, Gutting M, Lasch F, et al. Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study. ICMx. 2021 Dec;9(1):24.
Li Z, Wang H, Lu F. The development, feasibility and credibility of intra-abdominal pressure measurement techniques: A scoping review. Yan F, editor. PLoS ONE. 2024 Mar 21;19(3):e0297982.
Pereira BM, Dorigatti AE, Melek MZ, et al. Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome – a preliminary analysis. Anaesthesiol Intensive Ther. 2019 Oct 16;51(5):370–2.
Iyer D, Rastogi P, Åneman A, et al. Early screening to identify patients at risk of developing intra‐abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand. 2014 Nov;58(10):1267–75.
Smith S, Priestap F, Parry N, et al. Intraabdominal hypertension is less common than it used to be: A pilot step wedge trial. The Journal of Critical Care Medicine. 2025 Jan 1;11(1):95–100.
Gardner AK, Schroeder EL. Pathophysiology of intraabdominal hypertension and abdominal compartment syndrome and relevance to veterinary critical care. J Vet Emergen Crit Care. 2022 Jan;32(S1):48–56.
Dabrowski W, Rola P, Malbrain MLNG. Intra-abdominal pressure monitoring in cardiac surgery: is this the canary in the coalmine for kidney injury? J Clin Monit Comput. 2023 Apr;37(2):351–8.
Regli A, Reintam Blaser A, De Keulenaer B, et al. Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome – A sub-analysis of a prospective cohort. Journal of Critical Care. 2021 Aug;64:165–72.
Nasa P, Wise RD, Smit M, et al. International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome. World J Emerg Surg. 2024 Nov 29;19(1):39.
Perova-Sharonova VM, Albokrinov AA, Fesenko UA, et al. Effect of intraabdominal hypertension on splanchnic blood flow in children with appendicular peritonitis. Journal of Anaesthesiology Clinical Pharmacology. 2021 Jul;37(3):360–5.
Mohan S, Lim ZY, Chan KS, et al. Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome. Life. 2023 Jan 24;13(2):330.
Jayasundara S, Goonewardene M, Dassanayake L. The association between maternal intra-abdominal pressure and hypertension in pregnancy. Jayakody S, editor. PLoS ONE. 2023 Oct 18;18(10):e0284230.
