Manuel F Struck1, Andreas W Reske2, Thomas Schmidt3, Peter Hilbert4, Michael Steen5, Hermann Wrigge2. 1. Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany; Department of Plastic and Hand Surgery, Burn Trauma Centre, Bergmannstrost Hospital, Halle/Saale, Germany. Electronic address: manuelstruck@web.de. 2. Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany. 3. Department of Medical Psychology, Bergmannstrost Hospital, Halle/Saale, Germany. 4. Department of Anaesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital, Halle/Saale, Germany. 5. Department of Plastic and Hand Surgery, Burn Trauma Centre, Bergmannstrost Hospital, Halle/Saale, Germany.
Abstract
INTRODUCTION: The development of secondary abdominal compartment syndrome (ACS) is associated with multiple organ dysfunction. There is little information about the effects of decompressive laparotomy (DL) on respiratory function (RF) in burn patients developing ACS. PATIENTS AND METHODS: We retrospectively obtained data characterising RF from the database of an adult burn intensive care unit (BICU). Peak inspiratory pressure (Pip), PaO2/FiO2-ratio (P/F), static compliance (Cstat) and airway resistance (Raw) were analysed over the course of 60 h at 8 time points relative to DL. RESULTS: Thirty-five patients with ACS underwent DL with a mean percentage of total burned body surface area (TBSA) 39 ± 23% and mean intra-abdominal pressure 33 ± 7 mmHg. All patients presented with significantly deteriorating RF within 12h of DL (Pip 33 ± 4 to 39 ± 7 cm/H2O, p=0.003; P/F 232 ± 59 to 160 ± 55 mmHg, p<0.001, Cstat 34 ± 5 to 26 ± 6 mL/cmH2O, p<0.001; Raw 18 ± 3 to 24 ± 9 cm H2O/L/s, p=0.02). All these parameters improved significantly (p<0.001) after DL, regardless of the presence of inhalation injury or torso burns. Mortality was 71.4%. CONCLUSIONS: Variables characterising RF demonstrated a rapid deterioration before and a significant and sustained improvement after DL in burn patients developing ACS. Despite these respiratory improvements, DL was associated with low survival rates. Secondary ACS remains a challenge in burn patients and thus warrants particular attention during intensive care treatment.
INTRODUCTION: The development of secondary abdominal compartment syndrome (ACS) is associated with multiple organ dysfunction. There is little information about the effects of decompressive laparotomy (DL) on respiratory function (RF) in burn patients developing ACS. PATIENTS AND METHODS: We retrospectively obtained data characterising RF from the database of an adult burn intensive care unit (BICU). Peak inspiratory pressure (Pip), PaO2/FiO2-ratio (P/F), static compliance (Cstat) and airway resistance (Raw) were analysed over the course of 60 h at 8 time points relative to DL. RESULTS: Thirty-five patients with ACS underwent DL with a mean percentage of total burned body surface area (TBSA) 39 ± 23% and mean intra-abdominal pressure 33 ± 7 mmHg. All patients presented with significantly deteriorating RF within 12h of DL (Pip 33 ± 4 to 39 ± 7 cm/H2O, p=0.003; P/F 232 ± 59 to 160 ± 55 mmHg, p<0.001, Cstat 34 ± 5 to 26 ± 6 mL/cmH2O, p<0.001; Raw 18 ± 3 to 24 ± 9 cm H2O/L/s, p=0.02). All these parameters improved significantly (p<0.001) after DL, regardless of the presence of inhalation injury or torso burns. Mortality was 71.4%. CONCLUSIONS: Variables characterising RF demonstrated a rapid deterioration before and a significant and sustained improvement after DL in burn patients developing ACS. Despite these respiratory improvements, DL was associated with low survival rates. Secondary ACS remains a challenge in burn patients and thus warrants particular attention during intensive care treatment.
Authors: J J De Waele; E Kimball; M Malbrain; I Nesbitt; J Cohen; V Kaloiani; R Ivatury; M Mone; D Debergh; M Björck Journal: Br J Surg Date: 2016-02-18 Impact factor: 6.939
Authors: Joerg Schreiber; Axel Nierhaus; Eik Vettorazzi; Stephan A Braune; Daniel P Frings; Yogesh Vashist; Jakob R Izbicki; Stefan Kluge Journal: Crit Care Date: 2014-06-16 Impact factor: 9.097