Abdominal Compartiment Syndrome ACS and Cardiac Function

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Abdominal Compartiment Syndrome (ACS)and
Cardiac Function

• G. VERMEIREN
• Cardiology
• Intensive care Unit
• St Erasmus (ZNA STER)

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Thoraco-Abdominal Anatomy
Your View
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Thoraco-Abdominal Anatomy
Cardiological View
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Thoraco-Abdominal Unit PhilosophyTAU
P
-P
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Thoraco-Abdominal Unit PhilosophyTAU
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Impaired TAU Function - IAP
P
P
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Is Abdominal Hypertensionalways bad ?
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IAP is their BUSINESS
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Impaired TAU Function - IAP
Impaired ventilation High PEEP
P
Impaired (Decreased) Venous Return
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Impaired TAU Function
P
P
INCREASED AfterLoad DECREASE in Stroke Volume
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Kitano Y et al. J. Appl. Physiol. 69, 1990
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Normal Vascular Physiology in TAU
Pmean 6 mmHg
Pmean 70 mmHg
Pmean lt 5 mmHg
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Impaired Vascular Physiology in ACS
Pmean ?? mmHg
Pmean mmHg
Impaired Arterial Perfusion
Impaired Venous Return
gtgtgtgt
Pmean gt 20 mmHg
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An Unconvenient Truth

• Central Venous Pressure
• IAP elevates CVP if measured in VCI
• Venous Return is impaired
• BAD CORRELATION of CVP with Intravascular Fluid
  Status
• CVP may be high or low.
• NO Correlation with Circulating Intravascular
  Volume

TAKE HOME MESSAGE
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Kitano Y et al. J. Appl. Physiol. 69, 1990
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Unconvenient Truth (part II)

• CO SV x HR
• SV is generally DECREASED
• CO DECREASED
• MAP SAP are increased
• Increased cardiac Workload
• SVR is INCREASED
• Relative perfusion deficit in distal arterial bed
• Hypo-perfusion of multiple abdominal organs
• Multiple Organ Failure !!!

OXYGEN O2
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Take Home Messages

• CVP may be high or low
• No Correlation with CIV
• Heart Work Load increases
• SV CO decrease
• Periferal perfusion decreases
• IAP WASTE of ENERGY
• IAP NEGATIVE SPIRAL
• To MOF

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Therapy ?

• As a cardiologist you look into
• GOOGLE ...

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Yoga Solutions
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Solutions

• Filling the patient is paramount
• CVP has no correlation.
• Renal Function is important parameter
• Cardiac Sonography !!!!
• Preseve Cardiac Function
• Inotropes Vasopression
• Never delay Decompressive Laparotomy
• If MOF is imminent.
• Preventive DL ???

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High Pressure Let it all come out !!!
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Discovery of Murphys Law
Discovery of Gravity