BACKGROUND: Anticipation of abdominal compartment syndrome (ACS) is a factor for performing damage-control laparotomy (DCL). Recent years have seen changes in resuscitation patterns and a decline in the use of DCL. We hypothesized that reductions in both crystalloid resuscitation and the use of DCL is associated with a reduced rate of ACS in trauma patients. METHODS: We reviewed the records of all patients who underwent trauma laparotomies at our Level 1 trauma center over a 6-year period (2006-2011). We defined DCL as a trauma laparotomy in which the fascia was not closed at the initial operation. We defined ACS by elevated intravesical pressures and end-organ dysfunction. Our primary outcome measure was a development of ACS. RESULTS: A total of 799 patients were included. We noted a significant decrease in the DCL rate (39% in 2006 vs. 8% in 2011, p < 0.001), the crystalloid volume per patient (mean [SD], 12.8 [7.8] L in 2006 vs. 6.6 [4.2] L in 2011; p < 0.001), rate of ACS (7.4% in 2006 vs. 0% in 2011, p < 0.001), and mortality rate (22.8% in 2006 vs. 10.6% in 2011, p < 0.001). However, we noted no significant changes in the mean Injury Severity Score (ISS) (p = 0.09), in the mean abdominal Abbreviated Injury Scale (AIS) score (p = 0.17), and in the mean blood product volume per patient (p = 0.67). On multivariate regression analysis, crystalloid resuscitation (p = 0.01) was the only significant factor associated with the development of ACS. CONCLUSION: Minimizing the use of crystalloids and DCL was associated with better outcomes and virtual elimination of ACS in trauma patients. With the adaption of new resuscitation strategies, goals for a trauma laparotomy should be definitive surgical care with abdominal closure. ACS is a rare complication in the era of damage-control resuscitation and may have been iatrogenic. LEVEL OF EVIDENCE: Epidemiologic/therapeutic study, level IV.
BACKGROUND: Anticipation of abdominal compartment syndrome (ACS) is a factor for performing damage-control laparotomy (DCL). Recent years have seen changes in resuscitation patterns and a decline in the use of DCL. We hypothesized that reductions in both crystalloid resuscitation and the use of DCL is associated with a reduced rate of ACS in traumapatients. METHODS: We reviewed the records of all patients who underwent trauma laparotomies at our Level 1 trauma center over a 6-year period (2006-2011). We defined DCL as a trauma laparotomy in which the fascia was not closed at the initial operation. We defined ACS by elevated intravesical pressures and end-organ dysfunction. Our primary outcome measure was a development of ACS. RESULTS: A total of 799 patients were included. We noted a significant decrease in the DCL rate (39% in 2006 vs. 8% in 2011, p < 0.001), the crystalloid volume per patient (mean [SD], 12.8 [7.8] L in 2006 vs. 6.6 [4.2] L in 2011; p < 0.001), rate of ACS (7.4% in 2006 vs. 0% in 2011, p < 0.001), and mortality rate (22.8% in 2006 vs. 10.6% in 2011, p < 0.001). However, we noted no significant changes in the mean Injury Severity Score (ISS) (p = 0.09), in the mean abdominal Abbreviated Injury Scale (AIS) score (p = 0.17), and in the mean blood product volume per patient (p = 0.67). On multivariate regression analysis, crystalloid resuscitation (p = 0.01) was the only significant factor associated with the development of ACS. CONCLUSION: Minimizing the use of crystalloids and DCL was associated with better outcomes and virtual elimination of ACS in traumapatients. With the adaption of new resuscitation strategies, goals for a trauma laparotomy should be definitive surgical care with abdominal closure. ACS is a rare complication in the era of damage-control resuscitation and may have been iatrogenic. LEVEL OF EVIDENCE: Epidemiologic/therapeutic study, level IV.
Authors: John A Harvin; Lillian S Kao; Mike K Liang; Sasha D Adams; Michelle K McNutt; Joseph D Love; Laura J Moore; Charles E Wade; Bryan A Cotton; John B Holcomb Journal: J Am Coll Surg Date: 2017-04-23 Impact factor: 6.113
Authors: Andrew W Kirkpatrick; Paul B McBeth; Chad G Ball; Janeth C Ejike; Inneke E De Laet; Duncan Nickerson Journal: Plast Surg (Oakv) Date: 2016 Impact factor: 0.947
Authors: Andrew W Kirkpatrick; Federico Coccolini; Luca Ansaloni; Derek J Roberts; Matti Tolonen; Jessica L McKee; Ari Leppaniemi; Peter Faris; Christopher J Doig; Fausto Catena; Timothy Fabian; Craig N Jenne; Osvaldo Chiara; Paul Kubes; Braden Manns; Yoram Kluger; Gustavo P Fraga; Bruno M Pereira; Jose J Diaz; Michael Sugrue; Ernest E Moore; Jianan Ren; Chad G Ball; Raul Coimbra; Zsolt J Balogh; Fikri M Abu-Zidan; Elijah Dixon; Walter Biffl; Anthony MacLean; Ian Ball; John Drover; Paul B McBeth; Juan G Posadas-Calleja; Neil G Parry; Salomone Di Saverio; Carlos A Ordonez; Jimmy Xiao; Massimo Sartelli Journal: World J Emerg Surg Date: 2018-06-22 Impact factor: 5.469
Authors: Hao Wang; Richard D Robinson; Jessica Laureano Phillips; Alexander J Kirk; Therese M Duane; Johnbosco Umejiego; Melanie Stanzer; Mackenzie B Campbell-Furtick; Nestor R Zenarosa Journal: J Clin Med Res Date: 2015-10-23