- Title
- Mission to eliminate postinjury abdominal compartment syndrome
- Creator
- Balogh, Zsolt J.; Martin, Andrew; Van Wessem, Karlijin P.; King, Kate L.; Mackay, Peter; Havill, Ken
- Relation
- Archives of Surgery Vol. 146, Issue 8, p. 938-943
- Publisher Link
- http://dx.doi.org/10.1001/archsurg.2011.73
- Publisher
- American Medical Association
- Resource Type
- journal article
- Date
- 2011
- Description
- Objectives: To determine the current incidence of postinjury abdominal compartment syndrome (ACS), the effect of intra-abdominal hypertension (IAH) on trauma outcomes, and the independent predictors of postinjury IAH. Design: Prospective cohort study. Setting :University-affiliated level 1 trauma center. Patients: Eighty-one consecutive shock/trauma patients admitted to the intensive care unit (mean [SD] values: age, 41[2] years; 70% male; injury severity score, 29[1]; base deficit, 6[0.5] mmol/L; lactate level, 29.73[4.5] mg/dL; transfusions of packed red blood cells, 5[0.5] U in first 24 hours; mortality rate, 2.5%; and multiple organ failure [MOF], 6%) had second hourly intra-abdominal pressure (IAP) monitoring. Main Outcome Measures: Intensive care unit length of stay, ACS, IAH, MOF, mortality. Results: The mean (SD) IAP was 14 (1) mm Hg. No patients developed ACS. Sixty-one patients (75%) had sustained IAH. Both patients with IAH and those without had similar demographics and injury severity. Patients with IAH had worse metabolic acidosis (P = .02), received more crystalloids (P = .03), and underwent laparotomy more frequently (P = .005). One patient with IAH and one without died. MOF occurred in 1 patient without IAH (5%) vs 4 with IAH (7%). The mean (SD) intensive care unit length of stay was 11 (3) days in patients without IAH vs 8 (1) days in those with IAH. Intra-abdominal hypertension was poorly predictive of MOF (odds ratio, 1.17; 95% confidence interval, 0.96-1.43; P = .13). Of the 30 variables in multiple logistic regression analysis, only base deficit, laparotomy, and emergency department crystalloids were identified as weak predictors of IAP greater than 12 mm Hg. No predictors were found for the clinically more relevant IAP greater than 15 mm Hg and IAP greater than 18 mm Hg. Conclusions: Most of the severe shock/trauma patients developed sustained IAH. Based on univariate and multivariate analyses, there was no difference in outcomes between the trauma patients with IAH and those without. Multiple logistic regression analysis failed to show IAH as a predictor of MOF. The attenuation of the deadly ACS to a less deleterious IAH could be considered a success of the last decade in trauma and critical care. Postinjury abdominal compartment syndrome (ACS) was originally described as severe abdominal distension with raised peak airway pressures, carbon dioxide retention, and oliguria culminating in unplanned re-exploration following damage-control laparotomy. The seminal publications on ACS reported high mortality and incidence of multiple organ failure (MOF), with considerable intensive care resource use. Owing to recent advances in trauma and critical care (hemostatic resuscitation, open abdomen strategy, and advanced wound management options), the incidence and mortality rate of postinjury ACS is declining. Abdominal compartment syndrome in nontrauma populations (medical, mixed intensive care unit [ICU] populations) has always been less frequent but epidemiological studies of these populations have included intra-abdominal hypertension (IAH) as a predictor of poor outcome. The clinical relevance of sub-ACS IAH (elevated intra-abdominal pressure without organ dysfunction) in the shock/trauma population is largely unknown. We hypothesized that postinjury IAH is associated with poor outcome and is a predictor of MOF and death. The specific aims of this study were to determine (1) the incidence of IAH and ACS in the same high-risk population in which the predictors were originally described; (2) the effects of IAH on postinjury outcomes; and (3) the potential independent predictors of postinjury IAH.
- Subject
- multiple organ failure; damage control resuscitation; intraabdominal; hypertension; control laparotomy
- Identifier
- http://hdl.handle.net/1959.13/1044418
- Identifier
- uon:14324
- Identifier
- ISSN:0004-0010
- Language
- eng
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