Question: Isn't abdominal compartment syndrome (ACS) just a terminal event that occurs during the final processes of refractory shock/multiple organ failure (MOF)? If this is the case, it seems logical that abdominal compartment syndrome is simply a marker for death and we really should not worry about monitoring or treating this syndrome.

Response: First, abdominal compartment syndrome is actually not the terminal event caused by refractory shock/multiple organ failure. In fact, research evidence suggests just the opposite - that refractory shock and multiple organ failure are often caused by undetected and untreated abdominal compartment syndrome. Abdominal compartment syndrome is probably one of several "secondary insults" that lead to an overly aggressive immune response with inflammatory cytokine release.[1-7] The end result of this undetected and untreated "secondary insult" is multiple organ failure. So rather than being the terminal result, abdominal compartment syndrome is more likely a cause of multiple organ failure. Therefore interventions that prevent ACS can lead to reductions in progression to MOF. (See section - ACS interventions and effect on outcome).

1. Balogh, Z., et al., Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma, 2003. 54(5): p. 848-59; discussion 859-61.
2. Rezende-Neto, J.B., et al., Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure. J Trauma, 2002. 53(6): p. 1121-8.
3. Rezende-Neto, J.B., et al., The abdominal compartment syndrome as a second insult during systemic neutrophil priming provokes multiple organ injury. Shock, 2003. 20(4): p. 303-8.
4. Kacmaz, A., et al., Octreotide: a new approach to the management of acute abdominal hypertension. Peptides, 2003. 24(9): p. 1381-6.
5. Kacmaz, A., et al., Octreotide improves reperfusion-induced oxidative injury in acute abdominal hypertension in rats. J Gastrointest Surg, 2004. 8(1): p. 113-9.
6. Sener, G., et al., Melatonin ameliorates oxidative organ damage induced by acute intra-abdominal compartment syndrome in rats. J Pineal Res, 2003. 35(3): p. 163-8.
7. Bathe OF, Chow AW, and P. PT., Splanchnic origin of cytokines in a porcine model of mesenteric ischemia-reperfusion. Surgery, 1998. 123: p. 79-88.