Key Principles

  • Resuscitation and management of underlying condition
  • Treatments to improve wall compliance and evacuate intra-abdominal contents
  • Optimise tissue perfusion
Initial Resuscitation & Supportive Care
  • ABCDE approach:
    • Intubation and ventilation if respiratory distress
    • Optimize ventilatory support
    • Fluid and vasopressor resuscitation if compromised hemodynamics
  • Treat the underlying cause
Specific Management

1. Improve abdominal wall compliance:

  • Adequate sedation and analgesia
  • Ensure no external constriction e.g. dressings/eschars
  • Appropriate positioning:
    • Avoid proning/head up>20°
    • Consider reverse Trendelenburg positioning
    • Neuromuscular blockade

2. Treatments to evacuate intra-luminal content:

  • Nasogastric/rectal decompression via aspiration/free drainage of nasogastric/rectal tubes;
  • Administration of gastric/colonic prokinetics - caution after surgery
  • Reduce enteral nutrition volume
  • Enemas
  • Colonoscopic decompression

3. Treatments to identify and evacuate intra-abdominal collections:

  • Abdominal imaging
  • Drainage:
    • Percutaneous drainage or paracentesis
    • Surgical evacuation

4. Treatments to optimize fluid balance:

  • Optimal, not excessive, fluid resuscitation
  • Hypertonic solutions and colloids; diuretics to drive negative fluid balance if haemodynamically stable
  • Renal replacement therapy

5. Treatments to optimize tissue perfusion to maintain an abdominal perfusion pressure:

  • Use goal directed fluid resuscitation
  • Vasoactive drugs

If refractory to medical management consider surgical management with abdominal decompression

Referral, Monitoring & Deposition
  • Monitor IAP every 4-6 hours if elevated
  • The WSACS approach an algorithm with a 4 step approach for each treatment arm
  • Treatment arms should be addressed simultaneously and tailored to the individual patient