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Abdominal compliance: A bench-to-bedside review

Blaser, Annika Reintam MD, PhD; Björck, Martin MD, PhD; De Keulenaer, Bart MD, FCICM; Regli, Adrian MD

Journal of Trauma and Acute Care Surgery: May 2015 - Volume 78 - Issue 5 - p 1044–1053
doi: 10.1097/TA.0000000000000616
Review Article
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CME

ABSTRACT Abdominal compliance (AC) is an important determinant and predictor of available workspace during laparoscopic surgery. Furthermore, critically ill patients with a reduced AC are at an increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome, both of which are associated with high morbidity and mortality. Despite this, AC is a concept that has been neglected in the past.

AC is defined as a measure of the ease of abdominal expansion, expressed as a change in intra-abdominal volume (IAV) per change in intra-abdominal pressure (IAP):

AC = ΔIAV / ΔIAP

AC is a dynamic variable dependent on baseline IAV and IAP as well as abdominal reshaping and stretching capacity. Whereas AC itself can only rarely be measured, it always needs to be considered an important component of IAP. Patients with decreased AC are prone to fulminant development of abdominal compartment syndrome when concomitant risk factors for intra-abdominal hypertension are present.

This review aims to clarify the pressure-volume relationship within the abdominal cavity. It highlights how different conditions and pathologies can affect AC and which management strategies could be applied to avoid serious consequences of decreased AC.

We have pooled all available human data to calculate AC values in patients acutely and chronically exposed to intra-abdominal hypertension and demonstrated an exponential abdominal pressure-volume relationship. Most importantly, patients with high level of IAP have a reduced AC. In these patients, only small reduction in IAV can significantly increase AC and reduce IAPs.

A greater knowledge on AC may help in selecting a better surgical approach and in reducing complications related to intra-abdominal hypertension.

From the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine (A.R.B.), Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Anaesthesiology and Intensive Care (A.R.B.), University of Tartu, Tartu, Estonia; Section of Vascular Surgery (M.B.), Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Intensive Care Medicine (B.D.K., A.R.), Fremantle Hospital; and Medical School (A.R.), The University of Notre Dame Australia, Fremantle; and Schools of Surgery (B.D.K.), and School of Medicine and Pharmacology (A.R.), The University of Western Australia, Crawley; and Intensive Care Unit, Murdock Private Hospital (B.D.K.), Western Australia, Australia.

Submitted: November 19, 2014, Revised: January 25, 2015, Accepted: January 26, 2015.

Address for reprints: Annika Reintam Blaser, MD, PhD, Spitalstrasse, 6000 Lucerne 16, Switzerland; email: annika.reintam.blaser@ut.ee.

© 2015 Lippincott Williams & Wilkins, Inc.