Anthony di Natale1, Ueli Moehrlen2, Hannah Rachel Neeser2, Noëmi Zweifel2, Martin Meuli2, Andrea Alexis Mauracher3, Barbara Brotschi4, Sasha Job Tharakan2. 1. Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland. anthony.dinatale@kispi.uzh.ch. 2. Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland. 3. Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland. 4. Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.
Abstract
PURPOSE: Abdominal compartment syndrome (ACS) in children results in 100% mortality if left untreated. Decompressive laparotomy (DL) is the only effective treatment if conservative medical therapies have failed. This study aims to determine the incidence of ACS among pediatric patients who underwent an emergency laparotomy (EL), to describe the effect of DL on clinical and laboratory parameters and, to make a better prediction on fatal outcome, to analyze variables and their association with mortality. METHODS: This retrospective study includes 418 children up to the age of 16 years who underwent EL between January 2010 and December 2018 at our tertiary pediatric referral center. ACS was defined according to the latest guidelines of the World Society of the Abdominal Compartment Syndrome. RESULTS: Fourteen patients had emergency DL for ACS. 6 h preoperatively; median intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were 22.5 mmHg and 29 mmHg, respectively. After DL, IAP decreased and APP increased, both by an average of 60%. Six patients survived, eight patients had a fatal outcome, resulting in a mortality of 57%. An age under 1 year, weight under the 3rd percentile, an open abdomen treatment, an intestinal resection and an elevated serum lactate > 1.8 mmol/L were associated with an increased relative risk of death. CONCLUSIONS: Improving the outcome in pediatric patients with ACS by removing or attenuating risk factors is difficult. This emphasizes the need for early diagnosis and prompt DL once the diagnosis of ACS is made.
PURPOSE: Abdominal compartment syndrome (ACS) in children results in 100% mortality if left untreated. Decompressive laparotomy (DL) is the only effective treatment if conservative medical therapies have failed. This study aims to determine the incidence of ACS among pediatric patients who underwent an emergency laparotomy (EL), to describe the effect of DL on clinical and laboratory parameters and, to make a better prediction on fatal outcome, to analyze variables and their association with mortality. METHODS: This retrospective study includes 418 children up to the age of 16 years who underwent EL between January 2010 and December 2018 at our tertiary pediatric referral center. ACS was defined according to the latest guidelines of the World Society of the Abdominal Compartment Syndrome. RESULTS: Fourteen patients had emergency DL for ACS. 6 h preoperatively; median intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were 22.5 mmHg and 29 mmHg, respectively. After DL, IAP decreased and APP increased, both by an average of 60%. Six patients survived, eight patients had a fatal outcome, resulting in a mortality of 57%. An age under 1 year, weight under the 3rd percentile, an open abdomen treatment, an intestinal resection and an elevated serum lactate > 1.8 mmol/L were associated with an increased relative risk of death. CONCLUSIONS: Improving the outcome in pediatric patients with ACS by removing or attenuating risk factors is difficult. This emphasizes the need for early diagnosis and prompt DL once the diagnosis of ACS is made.
Authors: Farah Chedly Thabet; Iheb Mohamed Bougmiza; May Said Chehab; Hind Ali Bafaqih; Sulaiman Abdulkareem AlMohaimeed; Manu L N G Malbrain Journal: J Intensive Care Med Date: 2015-04-28 Impact factor: 3.510
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