Top

Journal of Trauma Management & Outcomes

Published in:

Open Access 01-12-2014 | Research

A necessary evil? Intra-abdominal hypertension complicating burn patient resuscitation

Authors: Paul B McBeth, Kim Sass, Duncan Nickerson, Chad G Ball, Andrew W Kirkpatrick

Published in: Journal of Trauma Management & Outcomes | Issue 1/2014

Abstract

Objective

Severe burns are devastating injuries that result in considerable systemic inflammation and often require resuscitation with large volumes of fluid. The result of massive resuscitation is often raised intra-abdominal pressures leading to Intra-abdominal hypertension (IAH) and the secondary abdominal compartment syndrome. The objective of this study is to conduct (1) a 10 year retrospective study to investigate epidemiological factors contributing to burn injuries in Alberta, (2) to characterize fluid management and incidence of IAH and ACS and (3) to review fluid resuscitation with a goal to identify optimal strategies for fluid resuscitation.

Design

A comprehensive 10-year retrospective review of burn injuries from 1999.

Outcome Measures

Age, sex, date, mechanism of injury, location of incident, on scene vitals and GCS, type of transport to hospital and routing, ISS, presenting vitals and GCS, diagnoses, procedures, complications, hospital LOS, ICU LOS, and events surrounding the injury.

Results

One hundred and seventy five patients (79.4% M, 20.6% F) were identified as having traumatic burn injuries with a mean ISS score of 21.8 (±8.3). The mean age was 41.6 (±17.5) (range 14-94) years. Nearly half (49.7%) of patients suffered their injuries at home, 17.7% were related to industrial incidents and 14.3% were MVC related. One hundred and ten patients required ICU admission. ICU LOS 18.5 (±8.8) days. Hospital LOS 38.0 (±37.8) days. The mean extent of burn injury was 31.4 (±20.9) % TBSA. Nearly half of the patients suffered inhalational injuries (mild 12.5%, moderate 13.7%, severe 9.1%). Thirty-nine (22.2%) of patients died from their injuries. Routine IAP monitoring began in September, 2005 with 15 of 28 patients having at least two IAP measurements. The mean IAP was 16.5 (±5.7) cm H₂O (range: 1-40) with an average of 58 (±97) IAP measurements per patient. Those patients with IAP monitoring had an average TBSA of 35.0 (±16.0)%, ISS of 47.5 (±7.5). The mean 48 hr fluid balance was 25.6 (±11.1)L exceeding predicted Parkland formula estimates by 86 (±32)%.

Conclusions

Further evaluation of IAP monitoring is needed to further characterize IAP and fluid resuscitation in patients with burn injuries.

Available only for authorised users

Baker SP, O'Neill B, Haddon W, Long WB: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974, 14: 187-196.CrossRefPubMed

Ball CG, Kirkpatrick AW, P McBeth PB: The secondary abdominal compartment syndrome: not just another post-traumatic complication. Can J Surg. 2008, 51 (5): 399-405.PubMedPubMedCentral

Kirkpatrick AW, Balogh Z, Ball CG, Ahmed N, Chun R, McBeth P, Kirby A, Zygun DA: The secondary abdominal compartment syndrome: iatrogenic or unavoidable?. J Am Coll Surg. 2006, 202 (4): 668-679.CrossRefPubMed

Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006, 32 (11): 1722-1732.CrossRefPubMed

Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007, 33 (6): 951-962.CrossRefPubMed

Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Holcomb JB, Ware DN, Moore FA: Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg. 2002, 184 (6): 538-543. discussion 543-4CrossRefPubMed

Fietsam R, Villalba M, Glover JL, Clark K: Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg. 1989, 55 (6): 396-402.PubMed

Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, Franciose RJ, Burch JM: The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001, 182 (6): 542-546.CrossRefPubMed

Madigan MC, Kemp CD, Johnson JC, Cotton BA: Secondary abdominal compartment syndrome after severe extremity injury: are early, aggressive fluid resuscitation strategies to blame?. J Trauma. 2008, 64 (2): 280-285.CrossRefPubMed

10.

Biffl WL, Moore EE, Burch JM, Offner PJ, Franciose RJ, Johnson JL: Secondary abdominal compartment syndrome is a highly lethal event. Am J Surg. 2001, 182 (6): 645-648.CrossRefPubMed

11.

Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, D'Aiuto M: Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma. 2000, 49: 387-391.CrossRefPubMed

12.

Ivy ME, Possenti PP, Kepros J, Atweh NA, D'Aiuto M, Palmer J, Pineau M, Burns GA, Caushaj PF: Abdominal compartment syndrome in patients with burns. J Burn Care Rehabil. 1999, 20: 351-353.CrossRefPubMed

13.

Hobson KG, Young KM, Ciraulo A, Palmieri TL, Greenhalgh DG: Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma. 2002, 53: 1129-1134.CrossRefPubMed

14.

Oda J, Ueyama M, Yamashita K, Inoue T, Noborio M, Ode Y, Aoki Y, Sugimoto H: Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. J Trauma. 2006, 60 (1): 64-71.CrossRefPubMed

15.

Oda J, Yamashita K, Inoue T, Harunari N, Ode Y, Mega K, Aoki Y, Noborio M, Ueyama M: Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns. Burns. 2006, 32 (2): 151-154.CrossRefPubMed

16.

O’Mara MS, Slater H, Goldfarb IW, Caushaj PF: A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma. 2005, 58 (5): 1011-1018.CrossRefPubMed

17.

Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L: Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005, 33 (2): 315-322.CrossRefPubMed

18.

Daugherty EL, Hongyan L, Taichman D, Hansen-Flaschen J, Fuchs BD: Abdominal compartment syndrome is common in medical intensive care unit patients receiving large-volume resuscitation. J Intensive Care Med. 2007, 22 (5): 294-299.CrossRefPubMed

19.

Latenser BA, Kowal-Vern A, Kimball D, Chakrin A, Dujovny N: A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil. 2002, 23: 190-195.CrossRefPubMed

20.

Hershberger RC, Hunt JL, Arnoldo BD, Purdue GF: Abdominal compartment syndrome in the severely burned patient. J Burn Care Res. 2007, 28 (5): 708-714.CrossRefPubMed

Title: A necessary evil? Intra-abdominal hypertension complicating burn patient resuscitation
Authors: Paul B McBeth
Kim Sass
Duncan Nickerson
Chad G Ball
Andrew W Kirkpatrick
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Journal of Trauma Management & Outcomes / Issue 1/2014
Electronic ISSN: 1752-2897
DOI: https://doi.org/10.1186/1752-2897-8-12

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A necessary evil? Intra-abdominal hypertension complicating burn patient resuscitation

Abstract

Objective

Design

Outcome Measures

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design

Outcome Measures

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

Management of intra-abdominal hypertension and abdominal compartment syndrome: a review

Traumatic injury among females: does gender matter?

Routinely recorded versus dedicated time registrations during trauma work-up

A feasibility study of 60 consecutive patients operated for unstable thoracic cage

Compartmental anatomical classification of traumatic abdominal injuries from the academic point of view and its potential clinical implication

Scapula fractures in complex shoulder injuries and floating shoulders: a classification based on displacement and instability