DOI: https://doi.org/10.22141/2224-0586.1.96.2019.158743

Prevention and treatment of abdominal compartment syndrome in patients with severe burn injury

G.A. Oliynyk, A.M. Lytovchenko, O.Yu. Lytovchenko

Abstract


Abdominal compartment syndrome (ACS) is defined as a sustained intra-abdominal pressure (IAP) > 20 mmHg (with or without an abdominal perfusion pressure < 60 mmHg) that is associated with new organ dysfunction/failure. Intra-abdominal hypertension (IAH) and ACS are associated with increased morbidity and mortality of patients. There are a lot of risk factors for IAH and ACS. Major burns are one of these factors. The generalized increase in capillary permeability that occurs in severe burn patients contributes to extensive edema formation and intra-peritoneal accumulation of “third-space” fluid. IAH/ACS should be suspected in all patients with severe burns. So, monitoring the IAP is the first step for establishing the importance of IAH/ACS in these patients. The use of excessive fluid resuscitation in combination with increased capillary permeability makes burned patients particularly vulnerable to the development of IAH, ACS, cardiovascular, respiratory, and renal system dysfunction. Key to the prevention of ACS is the early recognition and treatment of IAH. Resuscitation in the very first hours after a burn is of great importance in the treatment of severe burn shock. The choice of resuscitation fluid in severe burned patients also may have a clinical importance. For patients with severe burn injury, it is necessary to strive to restore microcirculation in the shortest possible time, using the minimum amount of fluid necessary to maintain the physiological functions of the body. Now novel resuscitation strategies to avoid IAH/ACS in burned patients are evolving. Recent evidence supports the use of hypertonic sodium chloride solution and colloids that can decrease overall fluid volume resuscitation. The use of saline only can be limited in cases where dehydration does not reach the stage of reducing the volume of circulating blood. If dehydration progresses to the stage of intravascular space reduction, then early administration of colloids is necessary. And later, saline can be administered to rehydrate the interstitial space. There is also growing evidence that vitamin C supplementation in the early post-burn period seems to decrease the required fluid volumes. Non-operative and percutaneous interventions may be used before surgical decompression. Nasogastric decompression, the use of neuromuscular blocking agents, prokinetic agents, enemas, or colonic decompression, the removal of excess fluid by percutaneous drainage, or by a combination of continuous veno-venous hemofiltration with ultrafiltration and/or diuretics are simple and possibly effective tools to reduce IAP. Circumferential abdominal burn eschars might also lead to ACS. Urgent decompressive escharotomy of the abdominal wall is a safe surgical procedure that provides rapid decrease of IAP. It improves ventilation, hemodynamic parameters, oxygen metabolism and can decrease morbidity and mortality. The open abdomen in trauma and non-trauma patients has been proposed to be effective in treating ACS if there are no other treatment options. However, it is necessary to pay a great attention to the high mortality with an open abdomen in patients with severe burns. Therefore, its use should be considered as the last step of despair, when other methods cannot be used. IAH is a common complication in patients with severe burn injuries. The development of ACS in these patients is associated with high mortality. Prevention, early detection and proper treatment of IAH will help avoid this usually fatal complication. The use of the minimum amount of solutions required to restore circulating blood volume and microcirculation helps prevent IAH and ACS in patients with severe burn injury.

Keywords


abdominal compartment syndrome; intra-abdominal hypertension; burns; fluid resuscitation; review

References


Malbrain M.L., Cheatham M.L., Kirkpatrick A. et al. Results from the International Conference of Experts on Intraabdominal Hypertension andAbdominal Compartment Syndrome. I. Definitions // Intensive Care Med. — 2006. — Vol. 32 (11). — P. 1722-1732.

Schein M., Rogers P.N. Schein’s common sense emergency abdominal surgery. Second Edition / M. Schein. — Springer-Verlag; Berlin; Heidelberg; New York, 2005. — 469 p.

Cheatham M.L., Malbrain M.L., Kirkpatrick A. et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations // Intensive Care Med. — 2007. — Vol. 33. — P. 951-962.

Kirkpatrick A.W., Roberts D.J., De Waele J. et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome // Intensive Care Med. — 2013. — Vol. 39(7). — P. 1190-206.

Newcombe J., Mathur M., Eike J.C. Abdominal compartment syndrome in children // Crit. Care Nurse. — 2012. — Vol. 32. — P. 51-61.

Schein M., Ivatury R. Intra-abdominal hypertension and the abdominal compartment syndrome // Br. J. Surg. — 1998. — 85. — P. 1027-1028.

Saaiq M. Abdominal compartment syndrome // J. Postgraduate Med. Inst. — 2006. — Vol. 20. — P. 297-301.

Sun K., Hancock B.J., Logsetty S. Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury // PlastSurg (Oakv). — 2015. — Vol. 23(4). — P. 218-220.

Vegar-Brozovic V., Stoic-Brezak J. Pathophysiology of abdominal compartment syndrome // Transplant. Proc. — 2006. — Vol. 38. — P. 833-835.

Kirkpatrick A.W., Ball C.G., Nickerson D., D’Amours S.K. Intraabdominal hypertension and the abdominal compartment syndrome in burn patients // World J. Surg. — 2009. — Vol. 33. — P. 1142-1149.

Demling R.H. The burn edema process: Current concepts // J. Burn Care Rehab. — 2005. — Vol. 26. — P. 207-227.

Kremer T., Harenberg P., Hernekamp F., Riedel K., Gebhardt M.M., Germann G., Heitmann C., Walther A. High-dose vitamin C treatment reduces capillary leakage after burn plasma transfer in rats // J. Burn Care Res. — 2010. — Vol. 31. — P. 470-479.

Ball C.G., Kirkpatrick A.W., Karmali S. et al. Tertiary abdominal compartment syndrome in the burn injured patient // J. Trauma. — 2006. — Vol. 61. — P. 1271-1273.

Azzopardi E.A., McWilliams B., Iyer S., Whitaker I.S. Fluid resuscitation in adults with severe burns at risk of secondary abdominal compartment syndrome — an evidence based systema­tic review // Burns. — 2009. — Vol. 35. — P. 911-920.

Oda J., Yamashita K., Inoue T. et al. Acute lung injury and multiple organ dysfunction syndrome secondary to intra-abdominal hypertension and abdominal decompression in extensively burned patients // J. Trauma. — 2007. — Vol. 62. — P. 1365-1369.

Ruiz-Castilla M., Barret J.P., Sanz D., Aguilera J., Serracanta J., García V., Collado J.M. Analysis of intra-abdominal hypertension in severe burned patients: the Valld'Hebron experience // Burns. — 2014. — Vol. 40(4). — P. 719-724.

Mbiine R., Alenyo R., Kobusingye O. et al. Intra-abdominal hypertension in severe burns: prevalence, incidence and mortality in a sub-Saharan African hospital // Int. J. Burns Trauma. — 2017. — Vol. 7(6). — P. 80-87.

Malbrain M.L., De Keulenaer B.L., Oda J. et al. Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine // Anaesthesiol. Intensive Ther. — 2015. — Vol. 47(3). — P. 228-240.

Wise R., Jacobs J., Pilate S. et al. Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature // Anaesthesiol. Intensive Ther. — 2016. — Vol. 48(2). — P. 95-109.

Strang S.G., Van Lieshout E.M., Breederveld R.S., Van Waes O.J. A systematic review on intra-abdominal pressure in severely burned patients // Burns. — 2014. — Vol. 40(1). — P. 9-16.

Ivy M.E. et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients // J. Trauma. — 2000. — № 49. — P. 387-391.

Oda J., Yamashita K., Inoue T. et al. Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns // Burns. — 2006. — Vol. 32. — P. 151-154.

McBeth P.B., Sass K., Nickerson D., Ball C.G., Kirkpatrick A.W. A necessary evil? Intra-abdominal hypertension complicating burn patient resuscitation // J. Trauma Manag. Outcomes. — 2014. — Vol. 8. — 12.

Ramirez J.I., Sen S., Palmieri T.L., Greenhalgh D.G. Timing of Laparotomy and Closure in Burn Patients with Abdominal Compartment Syndrome: Effects on Survival // J. Am. Coll. Surg. — 2018. — Vol. 226(6). — P. 1175-1180.

Talizin T.B., Tsuda M.S., Tanita M.T., Kauss I.A.M., Festti J., Carrilho C.M., Grion C.M.C., Cardoso L.T.Q. Acute kidney injury and intra-abdominal hypertension in burn patients in intensive care // Rev. Bras. Ter. Intensiva. — 2018. — Vol. 30(1). — P. 15-20.

Holodinsky J.K., Roberts D.J., Ball C.G., Blaser A.R., Starkopf J., Zygun D.A. et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis // Crit. Care. — 2013. — Vol. 17(5). — R. 249.

Kollias S., Stampolidis N., Kourakos P., Mantzari E., Koupidis S., Tsaousi S., Dimitrouli A., Atiyeh B., Castana O. Abdominal compartment syndrome (ACS) in a severely burned patient // Ann. Burns Fire Disasters. — 2015. — Vol. 28(1). — P. 5-8.

Regli A., De Keulenaer B., De Laet I., Roberts D., Dabrowski W., Malbrain M.L. Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension // Anaesthesiol. Intensive Ther. — 2015. — Vol. 47(1). — P. 45-53.

Burke B.A., Latenser B.A. Defining Intra-abdominal hypertension and abdominal compartment syndrome in acute thermal injury: a multicenter survey // J. Burn Care. — 2008. — Vol. 29. — P. 580-584.

Wassermann D. Systemic complications of extended burns // Ann. Chir. Plast. Esthet. — 2001. — Vol. 46, № 3. — P. 196-209.

Fujita T. Fluid resuscitation for burn patients at risk for abdominal complications // J. Am. Coll. Surg. — 2013. — Vol. 216(5). — P. 1027.

Tuggle D., Skinner S., Garza J., Vandijck D., Blot S. The abdominal compartment syndrome in patients with burn injury // Acta Clin. Belg. — 2007. — Vol. 62 (1). — P. 136-40.

Saffle J.I. The phenomenon of “fluid creep” in acute burn resuscitation // J. Burn Care Res. — 2007. — Vol. 28. — P. 382-395.

Atiyeh B.S., Dibo S.A., Ibrahim A.E., Zgheib E.R. Acute burn resuscitation and fluid creep: it is time for colloid rehabilitation // Ann. Burns Fire Disasters. — 2012. — Vol. 25. — P. 59-65.

Markell K.W., Renz E.M., White C.E. et al. Abdominal complications after severe burns // J. Am. Coll Surg. — 2009. — Vol. 208. — P. 940-949.

Hayek S., Ibrahim A., Abu Sittah G., Atiyeh B. Burn resuscitation: is it straightforward or a challenge? // Ann. Burns Fire Disasters. — 2011. — Vol. 24(1). — P. 17-21.

Hobson K.G., Young K.M., Ciraulo A., Palmieri T.L., Greenhalgh D.G. Release of abdominal compartment syndrome improves survival in patients with burn injury // J. Trauma. — 2002. — Vol. 53. — P. 1129-1134.

Greenhalgh D.G. Burn resuscitation: the results of the ISBI/ABA survey // Burns. — 2010. — Vol. 36(2). — P. 176-182.

Abu-Sittah G.S., Sarhane K.A. et al. Cardiovascular dysfunction in burns: review of the literature // Ann. Burns Fire Disasters. — 2012. — Vol. 25. — P. 26-37.

O’Mara M.S., Slater H., Goldfarb I.W., Caushaj P.F. A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients // J. Trauma. — 2005. — Vol. 58. — P. 1011-1018.

Horton J.W., Maass D.L., White J., Sanders B. Hypertonic saline-dextran suppresses burn-related cytokine secretion by cardiomyocytes // Am. J. Physiol. Heart Circ. Physiol. — 2001. — Vol. 280, Suppl. 4. — P. 1591-1601.

Литовченко А.Н., Цогоев А.А., Григорьева Т.Г., Олейник Г.А. Инфузионная терапия ожогового шока — еще раз об известном // Медицина неотложных состояний. — 2012. — № 4(43). — С. 9-13.

Endorf F.W., Dries D.J. Burn resuscitation // Scand. J. Trauma Resusc. Emerg. Med. — 2011. — Vol. 19, № 69. — P. 32-41.

De Keulenaer B., Regli A., De Laet I. et al. What's new in medical management strategies for raised intra-abdominal pressure: evacuating intra-abdominal contents, improving abdominal wall compliance, pharmacotherapy, and continuous negative extra-abdominal pressure // Anaesthesiol. Intensive Ther. — 2015. — Vol. 47(1). — P. 54-62.

Horton J.W. Free radicals and lipid peroxidation media­ted injury in burn trauma: the role of antioxidant therapy // Toxicology. — 2003. — Vol. 189, № 1-2. — P. 75-88.

Tanaka H., Matsuda T., Miyagantani Y., Yukioka T., Matsuda H., Shimazaki S. Reduction of resuscitation fluid volu­mes in severly burned patients using ascorbic acid administration: A randomized, prospective study // Arch. Surg. — 2000. — Vol. 135(3). — P. 326-331.

Kacmaz A., Polat A., User Y., Tilki M., Ozkan S., Se­ner G. Octreotide: a new approach to the management of acute abdominal hypertension // Peptides. — 2003. — Vol. 24. — P. 1381-1386.

Cheatham M.L., Safcsak K. Percutaneous catheter decompression in the treatment of elevated intraabdominal pressure // Chest. — 2011. — Vol. 140. — P. 1428-1435.

Latenser B.A., Kowal-Vern A., Kimball D. et al. A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury // J. Burn Care Rehabil. — 2002. — Vol. 23. — P. 190-195.

Coccolini F., Roberts D., Ansaloni L. et al. The open abdomen in trauma and non-trauma patients: WSES guidelines // World J. Emerg. Surg. — 2018. — Vol. 13, № 7.

Cheatham M.L., Safcsak K., Brzezinski S.J., Lube M.W. Nitrogen balance, protein loss, and the open abdomen // Crit. Care Med. — 2007. — Vol. 35. — P. 127-131.

Casaer M.P., Wilmer A., Hermans G., Wouters P.J., Mesotten D., Van den Berghe G. Role of disease and macronutrient dose in the randomized controlled epanic trial: a post hoc analysis // Am. J. Respir. Crit. Care Med. — 2013. — Vol. 187. — P. 247-255.

Reintam Blaser A., Starkopf J., Alhazzani W. et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines // Intensive Care Med. — 2017. — Vol. 43(3). — P. 380-398.




Copyright (c) 2019 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2019

 

   Seo анализ сайта