Zsolt J Balogh1, Andrew Martin, Karlijn P van Wessem, Kate L King, Peter Mackay, Ken Havill. 1. FRACS, Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, New South Wales, Australia 2310. zsolt.balogh@hnehealth.nsw.gov.au
Abstract
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.
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/traumapatients 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/traumapatients developed sustained IAH. Based on univariate and multivariate analyses, there was no difference in outcomes between the traumapatients 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.
Authors: Andrew W Kirkpatrick; Derek J Roberts; Jan De Waele; Roman Jaeschke; Manu L N G Malbrain; Bart De Keulenaer; Juan Duchesne; Martin Bjorck; Ari Leppaniemi; Janeth C Ejike; Michael Sugrue; Michael Cheatham; Rao Ivatury; Chad G Ball; Annika Reintam Blaser; Adrian Regli; Zsolt J Balogh; Scott D'Amours; Dieter Debergh; Mark Kaplan; Edward Kimball; Claudia Olvera Journal: Intensive Care Med Date: 2013-05-15 Impact factor: 17.440
Authors: Jessalyn K Holodinsky; Derek J Roberts; Chad G Ball; Annika Reintam Blaser; Joel Starkopf; David A Zygun; Henry Thomas Stelfox; Manu L Malbrain; Roman C Jaeschke; Andrew W Kirkpatrick Journal: Crit Care Date: 2013-10-21 Impact factor: 9.097