The Role of Routine Measurement of Intra-abdominal Pressure in Preventing Abdominal Compartment Syndrome.

INTRODUCTION: Abdomen, a closed compartment, is prone to raised intra-abdominal pressure (IAP) in the postoperative period. After a critical value of ≥ 15 cm of water, IAP produces abdominal compartment syndrome (ACS). ACS leads to reduced venous return, reduced cardiac output, and domino effect of organ dysfunction, leading to death. Hence, it is the need of hour to monitor IAP to pick up intra-abdominal hypertension (IAH) and ACS. This routine facilitates early institution of treatment measures.

AIMS AND OBJECTIVES: To study IAP in abdominal operations in neonates, infants, and older children and to promote concept of routine measurement of IAP as standard care.

MATERIALS AND METHODS: Intravesical route was used to measure IAP in this prospective observational study. Seventy-nine pediatric abdominal surgeries met with criteria of availability of complete data for analysis and formed the cohort of the study. All major, infective, traumatic, tumor-related abdominal surgeries were included in the study. Outcome, C-reactive protein (CRP), procalcitonin, platelet counts, Simplified Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were the parameters analyzed. The World Society of ACS grading was adopted in the study with subdivision of normal into low-normal and high-normal subgroups.

RESULTS: Extended Mantel-Haenszel Chi-square statistical tool when applied for linear relationship showed a linear relationship with outcome ( P < 0.05), CRP ( P < 0.05), procalcitonin ( P < 0.05), Simplified Sequential organ failure Assessment Score, and APACHE II. Platelet counts ( P > 0.05) were not significantly correlated. Decision for laparotomy was delayed in cases of ACS.

CONCLUSION: Routine measure of IAP facilitates early recognition of IAH. This facilitates therapeutic measures to be initiated to reduce IAP. Early decision to decompress by laparotomy/laparostomy saves lives. Hence, routine IAP measurement should be a part of standard care in pediatric abdominal surgery.