A systematic review on intra-abdominal pressure in severely burned patients

Strang, S.G.; Lieshout, Esther M.M. Van; Breederveld, R.S.; Waes, Oscar J.F. Van

doi:10.1016/j.burns.2013.07.001

Cited by 78 publications

(39 citation statements)

References 59 publications

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“…The results of this study support the hypothesis that (secondary) IAH and ACS are more prevalent in mechanically ventilated burn patients compared to other groups of critically ill patients [6,24,25]. Early implementation of medical interventions (as was performed in our study) is useful in improving IAP, oxygenation, and potentially venous return to the right side of the heart.…”

Section: Prognosissupporting

confidence: 84%

Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

Wise

Jacobs²,

Pilate³

et al. 2016

Anaesthesiol Intensive Ther

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Background: Burn patients are at high risk for secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) due to capillary leak and large volume fluid resuscitation. Our objective was to examine the incidence the incidence of IAH and ACS and their relation to outcome in mechanically ventilated (MV) burn patients. Methods: This observational study included all MV burn patients admitted between April 2007 and December 2009. Various physiological parameters, intra-abdominal pressure (IAP) measurements and severity scoring indices were recorded on admission and/or each day in ICU. Transpulmonary thermodilution parameters were also obtained in 23 patients. The mean and maximum IAP during admission was calculated. The primary endpoint was ICU (burn unit) mortality. Results: Fifty-six patients were included. The average Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores were 43.4 ± 15.1 and 6.4 ± 3.4, respectively. The average total body surface area (TBSA) affected by burns was 24.9% ( ± 24.9), with 33 patients suffering inhalational injuries. Forty-four (78.6%) patients developed IAH and 16 (28.6%) suffered ACS. Patients with ACS had higher TBSAs burned (35.8 ± 30 vs 20.6 ± 21.4%, P = 0.04) and higher cumulative fluid balances after 48 hours (13.6 ± 16L vs 7.6 ± 4.1L, P = 0.03). The TBSA burned correlated well with the mean IAP (R = 0.34, P = 0.01). Mortality was notably high (26.8%) and significantly higher in patients with IAH (34.1%, P = 0.014) and ACS (62.5%, P < 0.0001). Most patients received more fluids than calculated by the Parkland Consensus Formula while, interestingly, non-survivors received less. However, when patients with pure inhalation injury were excluded there were no differences. Non-surgical interventions (n = 24) were successful in removing body fluids and were related to a significant decrease in IAP, central venous pressure (CVP) and an improvement in oxygenation and urine output. Non-resolution of IAH was associated with a significantly worse outcome (P < 0.0001). Conclusion: Based on our preliminary results we conclude that IAH and ACS have a relatively high incidence in MV burn patients compared to other groups of critically ill patients. The percentage of TBSA burned correlates with the mean IAP. The combination of high CLI, positive (daily and cumulative) fluid balance, high IAP, high EVLWI and low APP suggest a poor outcome. Non-surgical interventions appear to improve end-organ function. Non-resolution of IAH is related to a worse outcome.

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Section: Prognosissupporting

confidence: 84%

Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

Wise

Jacobs²,

Pilate³

et al. 2016

Anaesthesiol Intensive Ther

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“…In a pilot study, Latenser et al (13) concluded it was a 'safe and effective' way to reduce intra-abdominal pressure and prevent ACS. Additionally, both a recent systematic review (14), and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome (15) recommended that percutaneous catheter drainage precede decompressive laparotomy, especially in children. The treatment for this child followed these current recommendations and treatment algorithm from the World Society of the Abdominal Compartment Syndrome (15), including attempts to restrict the amount of intravenous fluid, use of gastric decompression, neostigmine and, eventually, percutaneous drainage.…”

Section: Discussionmentioning

confidence: 99%

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

2015

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“…A recent systematic [6]. All patients with ACS had received more than 300 mL kg -1 24h -1 and had more than 50% TBSA review showed that the prevalence of ACS and IAH in severely burned patients is 4.1−16.6% and 64.7−74.5%, respectively [9]. The mean mortality rate for ACS in burn patients is 74.8%.…”

Section: Intra-abdominal Hypertension In Burn Patients Pathophysiologmentioning

confidence: 99%

“…In severe burn patients, the kidneys are especially vulnerable to elevated IAP-related injury [10]. Markers for IAP-related organ damage might be superior to IAP measurement itself [9]. Thus, clinicians must accurately monitor patient fluid balance in the resuscitation period.…”

Section: Intra-abdominal Hypertension In Burn Patients Pathophysiologmentioning

confidence: 99%

“…Indeed, the use of plasma and hypertonic lactated resuscitation may prevent IAH or ACS. Despite the fact that colloids decrease resuscitation volume needs, no benefit in preventing IAH has been proven [9]. In order to assess correctly the fluid status of the burned patient, transpulmonary thermodilution monitoring and measurement of volumetric indices like global end-diastolic volume (GEDV) and EVLW may be warranted in combination with functional hemodynamics [13, 14, 19−21].…”

Section: Prevention and Diagnosis Of Iah And Acs In Burn Patientsmentioning

confidence: 99%

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Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

Malbrain¹,

Keulenaer²,

Oda³

et al. 2015

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns.

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A systematic review on intra-abdominal pressure in severely burned patients

Cited by 78 publications

References 59 publications

Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

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