Abdominal compartment syndrome (ACS) is a life-threatening syndrome that is increasing in incidence amongst critically ill patients. A 2005 survey of critical care nurses revealed that there were recognised knowledge deficits of ACS amongst surveyed nurses. The purpose of this review is to inform critical care nurses about ACS and its antecedent, intra abdominal hypertension (IAH). Detection techniques, causes, clinical manifestations and pathophysiology of IAH and ACS will be outlined and medical and nursing management will be reviewed. The incidence of ACS is reported to be up to 35% in the intensive care population with reduced survival when compared to other intensive care patients. Physiological changes that occur with ACS include compromise to the cardiovascular, respiratory, renal and neurological systems and development of metabolic acidosis. Management may incorporate percutaneous drainage of ascitic fluid, use of muscle relaxants, prone positioning and surgical intervention to open, decompress and gradually close the abdomen. Throughout this care the critical care nurse should ensure accurate monitoring of organ function, assessment for recurrence of ACS as well as the amount and type of drainage, appropriate wound management and provision of physical and psychosocial support of the patient. These aspects of care have the potential to impact significantly on patient outcome.