Both Primary and Secondary Abdominal Compartment Syndrome can be Predicted Early and are Harbingers of Multiple Organ Failure

Balogh, Zsolt J.; McKinley, Bruce A.; Holcomb, John B.; Miller, Charles C.; Cocanour, Christine S.; Kozar, Rosemary A.; Valdivia, Alicia; Ware, Drue N.; Moore, Frederick A.

doi:10.1097/01.ta.0000070166.29649.f3

Cited by 340 publications

(275 citation statements)

References 32 publications

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“…It often results from a mismatch between the fluids required and the fluids administered. This situation must be distinguished from occult bleeding and from intrathoracic hypertension that may result from a tension pneumothorax [29,30], a massive diaphragmatic hernia [31-34], or intra-abdominal hypertension [36,37]. On rare occasions cardiac tamponade will result from a missed cardiac wound or from liquid accumulation in the pericardial sac after a wound or an incision (Table 2) [100][101][102].…”

Section: The Hypotense or Hypoperfused Trauma Patient In The Icumentioning

confidence: 99%

“…The elevated intrathoracic pressure hinders lung expansion and oxygenation. The mechanically ventilated patient shows elevated airway pressures, hypoxemia, and sometimes hypercarbia [31, 36,37]. The physical examination can identify asymmetry in tension pneumothorax and diaphragmatic hernia.…”

Section: The Hypotense or Hypoperfused Trauma Patient In The Icumentioning

confidence: 99%

“…This complex may be attributed to acute lung injury or atelectasis. Nevertheless, it may correspond to an extrapulmonary cause, that is, tension pneumothorax [29,30], massive diaphragmatic hernia [31][32][33][34], or intraabdominal hypertension [35][36][37]. Clearly, diagnosing these entities has critical transcendence, as they cause rapid hemodynamic deterioration and are susceptible to specific surgical treatment (Fig.…”

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Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Section: The Hypotense or Hypoperfused Trauma Patient In The Icumentioning

confidence: 99%

Section: The Hypotense or Hypoperfused Trauma Patient In The Icumentioning

confidence: 99%

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Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…An increase in IAP ≥ 20 mmHg is associated with a marked reduction in cardiac output and oliguria. In a recent study, a mortality rate of up to 64% was reported in patients with urinary bladder pressure over 25 mmHg (grade III) and organ dysfunction, when ACS was due to the presence of intra-abdominal or retroperitoneal pathology (10).…”

Section: Discussionmentioning

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A rare cause of abdominal compartment syndrome: acute trichlorethylene overdose

Liotier

Plantefève

Dualé

et al. 2008

Clinical Toxicology

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Supranormal Trauma Resuscitation Causes More Cases of Abdominal Compartment Syndrome

Balogh¹

2003

Arch Surg

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447

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Hypothesis: Normal resuscitation (oxygen delivery index [DO 2 I] Ն500 mL/min per square meter), compared with supranormal trauma resuscitation (DO 2 I Ն600 mL/min per square meter), requires less crystalloid volume, thus decreasing the incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Design: Retrospective analysis of a prospective database. Setting: Twenty-bed intensive care unit (ICU) in a regional level I trauma center. Patients: Patients with major trauma (injury severity score Ͼ15, initial base deficit Ն6 mEq/L, or need for Ն6 units of packed red blood cells in the first 12 hours) or age 65 years or older with any 2 of the previous criteria. Interventions: Shock/trauma resuscitation protocol: pulmonary artery catheter, gastric tonometry, urinary bladder pressure measurements, lactated Ringer infusion, packed red blood cell transfusion, and moderate inotrope support, as needed, in that sequence, to attain and maintain a DO 2 I greater than or equal to 600 mL/min per m 2 (16 months, ending January 1, 2001, n=85) or a DO 2 I greater than or equal to 500 mL/min per square meter (16 months, starting January 1, 2001, n=71) for the first 24 hours in the ICU. Main Outcome Measures: Lactated Ringer infusion volume (liters) at ICU admission, gastric partial carbon dioxide minus end-tidal carbon dioxide (GAP CO2), IAH (urinary bladder pressure measurements Ͼ20 mm Hg), ACS (urinary bladder pressure measurements Ͼ25 mm Hg with organ dysfunction), multiple organ failure, and mortality. Results: Demographics, injury severity, and shock severity parameters were similar in both groups. The supranormal resuscitation group required more lactated Ringer infusion volume in the first 24 hours in the ICU (mean ± SD, 13 ± 2 vs 7 ± 1 L; PϽ.05) and had higher GAP CO2 (16 ± 2 vs 7 ± 1 mm Hg; PϽ.05). In the supranormal group, IAH (42% vs 20%; PϽ.05) and ACS (16% vs 8%; PϽ.05) were more frequent. The conventional trauma outcomes, such as multiple organ failure (22% vs 9%; PϽ.05) and mortality (27% vs 11%; PϽ.05) were less favorable in the supranormal resuscitation group. Conclusion: Supranormal resuscitation, compared with normal resuscitation, was associated with more lactated Ringer infusion, decreased intestinal perfusion (higher GAP CO2), and an increased incidence of IAH, ACS, multiple organ failure, and death.

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Both Primary and Secondary Abdominal Compartment Syndrome can be Predicted Early and are Harbingers of Multiple Organ Failure

Cited by 340 publications

References 32 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

A rare cause of abdominal compartment syndrome: acute trichlorethylene overdose

Supranormal Trauma Resuscitation Causes More Cases of Abdominal Compartment Syndrome

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