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