Guideline sources The following summarized guidelines for the evaluation and management of abdominal compartment syndrome are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES 2018), the European Society for Vascular Surgery (ESVS 2017), and the World Society of the Abdominal Compartment Syndrome (WSACS 2013). 1 2 3 Guidelines 1. Diagnostic investigations Measurement of intra-abdominal pressure: As per WSES 2018 guidelines, obtain intra-abdominal pressure measurement in critically ill patients at risk for intra-abdominal hypertension/abdominal compartment syndrome. B As per ESVS 2017 guidelines, obtain intra-abdominal pressure monitoring to prevent non- occlusive mesenteric ischemia in patients with known risk factors for intraabdominal hypertension/abdominal compartment syndrome. B As per WSACS 2013 guidelines, obtain intra-abdominal pressure measurement when any known risk factor for intra-abdominal hypertension/abdominal compartment syndrome is present in a critically ill or trauma patient. B https://web.pathway.md/diseases/recGaFLYS9MVjCahO 1/3 6/23/23, 1:18 AM Abdominal compartment syndrome Pathway 2. Medical management Supportive care: consider providing optimal pain and anxiety relief in critically ill or trauma patients. C Neuromuscular blocking agents: consider administering brief trials of neuromuscular blockade as a temporizing measure in the treatment of intra-abdominal hypertension/abdominal compartment syndrome. C Fluid resuscitation: consider using a protocol to try and avoid a positive cumulative fluid balance in critically ill or trauma patients with or at risk of intra-abdominal hypertension/abdominal compartment syndrome after the acute resuscitation has been completed and the inciting issues have been addressed. C Neostigmine: consider administering neostigmine for the treatment of established colonic ileus not responding to other simple measures and associated with intra-abdominal hypertension. C 3. Therapeutic procedures Blood product transfusion: consider using an enhanced ratio of plasma/packed RBCs for resuscitation of massive hemorrhage. C Enteral decompression: consider performing enteral decompression with nasogastric or rectal tubes when the stomach or colon are dilated in the presence of intra-abdominal hypertension/abdominal compartment syndrome. B Percutaneous catheter drainage: Consider performing percutaneous catheter drainage, if technically possible, to remove fluid (in the setting of obvious intraperitoneal fluid) in patients with intra-abdominal hypertension/abdominal compartment syndrome. C Consider performing percutaneous catheter drainage, technically possible, to remove fluid (in the setting of obvious intraperitoneal fluid) in patients with intra-abdominal hypertension/abdominal compartment syndrome rather than immediate decompressive laparotomy, as this may alleviate the need for decompressive laparotomy. C 4. Surgical interventions Decompressive laparotomy: As per WSES 2018 guidelines, recognize that risk factors for abdominal compartment syndrome, such as damage control surgery, injuries requiring packing and planned reoperation, extreme visceral or retroperitoneal swelling, obesity, elevated bladder pressure when abdominal closure is attempted, abdominal wall tissue loss, and aggressive resuscitation, are predictors of the necessity for open abdomen in patients with trauma. B Show 6 more https://web.pathway.md/diseases/recGaFLYS9MVjCahO 2/3 6/23/23, 1:18 AM Abdominal compartment syndrome Pathway As per ESVS 2017 guidelines, perform decompression laparotomy to prevent non-occlusive mesenteric ischemia in patients with abdominal compartment syndrome (defined as an intra- abdominal pressure > 20 mmHg and newly developed organ dysfunction or failure). B As per WSACS 2013 guidelines, perform decompressive laparotomy in critically ill adult patients with overt abdominal compartment syndrome. B Show 3 more 5. Specific circumstances Patients with open abdominal wounds: Utilize negative pressure wound therapy in critically ill/injured patients with open abdominal wounds. B Attempt to perform an early or at least same-hospital-stay abdominal fascial closure in ICU patients with open abdominal wounds. B References 1. Andrew W Kirkpatrick, Derek J Roberts, Jan De Waele 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. Open 2. Federico Coccolini, Derek Roberts, Luca Ansaloni et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018 Feb 2;13 7. Open 3. M Bj rck, M Koelemay, S Acosta et al. Editor's Choice Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery ESVS . Eur J Vasc Endovasc Surg. 2017 Apr;53 4 460 510. Open https://web.pathway.md/diseases/recGaFLYS9MVjCahO 3/3