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Resumen
Si bien el estudio de la presión intraabdominal (PIA) tiene más de 100 años, es en los últimos 5 cuando se han desarrollado los conceptos de hipertensión intraabdominal (HIA) y síndrome compartimental abdominal (SCA) como entidades clínicas de interés en el ámbito de los cuidados intensivos. En diciembre de 2004, en el primer Congreso del Síndrome Compartimental Abdominal, se alcanzó una serie de definiciones, publicadas en 2006. La HIA se define como la PIA ≥ 12 mmHg y se clasifica en 4 grados de gravedad, siendo el SCA el grado máximo, con el desarrollo de fracaso multiorgánico.
La incidencia de HIA en pacientes de unidades de cuidados intensivos es elevada, en torno al 30% al ingreso y del 64% con estancias de 7 días. El aumento de PIA conduce a una disminución del flujo vascular a los órganos esplácnicos, un aumento de la presión intratorácica y una disminución del retorno venoso, con una importante caída del gasto cardíaco.
Estos episodios fisiopatológicos se siguen, en caso de persistir la HIA, del desarrollo de fallo orgánico múltiple, con fracaso renal, cardiocirculatorio, respiratorio e isquemia intestinal. La mortalidad del SCA sin tratamiento es mayor del 60%. La descompresión quirúrgica es el único tratamiento para los pacientes con SCA. En los pacientes con HIA moderada se debe intentar optimizar el tratamiento médico. Éste se basa en: a) monitorización seriada de la PIA; b) optimización de la perfusión sistémica y de la función de los diferentes sistemas en los pacientes con PIA elevada; c) instaurar medidas específicas para disminuir la PIA, y d) la descompresión quirúrgica precoz para la HIA refractaria.
La implantación de las medidas médicas que puedan disminuir la PIA y la realización precoz de la descompresión abdominal en caso de SCA mejoran la sobrevida de los pacientes críticos con HIA.
Palabras clave:
Hipertensión intraabdominal
Fallo multiorgánico
Mortalidad
Abstract
Although intraabdominal pressure (IAP) has been studied for more than 100 years, the concepts of intraabdominal hypertension (IAH) and abdominal compartmental syndrome (ACS) have only been developed as clinical entities of interest in intensive care in the last 5 years. At the first Congress on Abdominal Compartment Syndrome in December 2004, a series of definitions were established, which were published in 2006. IAH is defined as IAP ≥ 12 mmHg and is classified in four severity grades, the maximum grade being ACS, with the development of multiorgan failure.
The incidence of IAH in patients in intensive care units is high, around 30% at admission and 64% in those with a length of stay of 7 days. The increase in IAP leads to reduced vascular flow to the splenic organs, increased intrathoracic pressure and decreased venous return, with a substantial reduction in cardiac output.
If IAH persists, these physiopathologic episodes are followed by the development of multiorgan failure with renal, cardiocirculatory and respiratory failure and intestinal ischemia. Mortality from untreated ACS is higher than 60%. The only treatment for ACS is surgical decompression. In patients with moderate IAH, medical treatment should be optimized, based on the following measures: a) serial IAP monitoring; b) optimization of systemic perfusion and the function of the distinct systems in patients with high IAP; c) instauration of specific measures to decrease IAP; and d) early surgical decompression for refractory IAH. The application of the medical measures that can reduce IAP and early abdominal decompression in ACS improve survival in critically ill patients with IAH.
Keywords:
Intraabdominal hypertension
Multiorgan failure
Mortality
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