síndrome compartamental abdominal
DESCRIPTION
TRANSCRIPT
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Síndrome compartamental abdominal
R1CG Aldo MárquezR1CG Edgar Vargas
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Definición
• Presión intraabdominal sostenida > 20 mmHg que se acompaña de disfunción o falla orgánica.
• HIA: elevación de la presión intraabdominal patológica >12 mm Hg.
• Presión normal: entre 2 y 5 mmHg
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Definición
• Presión de perfusión abdominal: tensión arterial media – presión intraabdominal.
• Una presión de 60 mmHg es lo ideal.
• Niveles menores incrementan el riesgo de disfunción orgánica.
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Tipos
• Primario– Causa intraabdominal o intrapélvica (lesiones
ocupantes de espacio).• Secundario– Posterior a situaciones que requieren resucitación
masiva con líquidos.• Terciario– Recurrente.
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
![Page 6: Síndrome compartamental abdominal](https://reader035.vdocuments.pub/reader035/viewer/2022062616/5492d348b4795970538b45c1/html5/thumbnails/6.jpg)
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
![Page 7: Síndrome compartamental abdominal](https://reader035.vdocuments.pub/reader035/viewer/2022062616/5492d348b4795970538b45c1/html5/thumbnails/7.jpg)
Fisiopatología
• Incidencia– 0.5 a 8. (hasta 14% en trauma) del 1 al 20% en
quemados.
Parsak CK, Seydaoglu G, Sakman G, et al. Abdominal compartment syndrome: current problems and new strategies.World J Surg 2008;32:13e19.
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Fisiopatología
• Edema intestinal– Disminuye• Perfusión intestinal• Perfusión renal• Capacidad ventilatoria
Parsak CK, Seydaoglu G, Sakman G, et al. Abdominal compartment syndrome: current problems and new strategies.World J Surg 2008;32:13e19.
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Efectos en organismo
• Renal• Respiratorio• Cardiaco• Esplácnico
Harman PK, Kron IL, McLachlan HD, et al. Elevated intraabdominalpressure and renal function. Ann Surg 1982;196: 594e597.
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Efectos en organismo
• Renal– Incremento• Resistencias vasculares
– Disminución• Perfusión renal
Harman PK, Kron IL, McLachlan HD, et al. Elevated intraabdominalpressure and renal function. Ann Surg 1982;196: 594e597.
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Harman PK, Kron IL, McLachlan HD, et al. Elevated intraabdominalpressure and renal function. Ann Surg 1982;196: 594e597.
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Efectos en organismo
• Respiratorio– Incremento de presión intratorácica– Disminución de capacidad de expansión torácica.
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Efectos en organismo
• Cardiaco (>15 mmHg)– Disminuye retorno venoso– Aumenta pos carga – Falsa elevación de la PVC
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Efectos en organismo
• Cerebral– Incrementa presión intracraneal de acuerdo al
incremento de la presión intraabdominal.
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Efectos en organismo
• Esplácnico– Presión >20 mmHg– Disminución de flujo• Venoso portal 35%• Hepático arterial 55%
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Diagnóstico
• Medición de presión intraabdominal• >2 factores de riesgo
Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg2002;26:1428e1431.
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Manejo
• Sangre:plasma 1:1• Laparotomía descompresiva• Abdomen abierto• Terapia de reemplazo renal. Hemofiltración o
ultrafiltración.
Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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Alfred J. Abdominal Compartment Syndrome: A decade of Progress. J Am Coll Surg. 2012.09.004
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• Gracias