Secondary
intra-abdominal hypertension (IAH) and
abdominal compartment syndrome (ACS) are closely related to fluid
resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and
resuscitation, and to explore a new hypothesis with regard to damage control
resuscitation, permissive
hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search. The recognition of the association between the development of ACS and
resuscitation urged the need for new approach in
traumatic shock management. Over a decade after wide spread application of damage control surgery damage control
resuscitation was developed. DCR differs from previous
resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like
acidosis and
hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle'. Permissive
hypotension involves keeping the
blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive
crystalloid resuscitation have been described. Limitation of fluid intake by using
colloids, hypertonic saline (HTS) or
hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and
electrolytes with or without
protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic
inflammation failing to curtail transcapillary
albumin leakage and resulting in increasingly positive net fluid balances. GIPS may represent a third hit after the initial insult and the ischaemia
reperfusion injury. Novel markers like the capillary leak index, extravascular lung water and pulmonary permeability index may help the clinician in guiding appropriate fluid management. Capillary leak is an inflammatory condition with diverse triggers that results from a common pathway that includes ischaemia-reperfusion, toxic
oxygen metabolite generation, cell wall and
enzyme injury leading to a loss of capillary endothelial barrier function. Fluid overload should be avoided in this setting.