ECMO-/ECLS

resuscitation, oliguria despite volume repletion, elevated peak airway
pressures, hypercarbia refractory to increased mechanical ventilation, and
hypoxemia refractory to increased FiO2 and PEEP, and intracranial
hypertension.
Abdominal compartment syndrome can be seen in several pediatric
situations including severe penetrating and blunt abdominal trauma with
prolonged operative intervention, prolonged shock, and burns with high volume
resuscitation. Other causes of ACS include pancreatitis, ischemic bowel, pelvic
fracture, ascites, and tumor.
Bladder pressure is the most common method of measuring IAP. A foley
catheter is placed to drain the urine, then 1 ml.kg body weight of sterile saline is
instilled into the bladder. The end of the Foley is connected to a pressure
transducer or a manometer via a 3-way stocpock. The transducer is placed at
the height of the public symphysis as the “zero point”. Since water is used, the
value obtained is converted to mm Hg by dividing the value by 1.36 (1 mm
Hg=1.36 cm H 2 O.
Abdominal Perfusion Pressue is the difference between Mean Arterial
Pressure and IAP. Normal abdominal perfusion pressure should be greater
than 50 mm Hg. Some authors feel that abdominal perfusion pressure is a
better predictor of end organ injury than lactate, pH, urine output, or base
deficit.
Treatment of ACS is dictated by the physiologic effects. If IAP is 10- 25 mm
Hg, maintaining normovolemia and sometimes hypervolemia may be adequate.