Abdominal compartment syndrome in the severely burned patient

Scant data exist regarding patient outcome after treatment of abdominal compartment syndrome (ACS) with decompressive laparotomy. This work reviews the outcome of 25 burn patients at a single institution who underwent decompressive laparotomy for treatment of ACS in the periresuscitation period. A computerized burn registry and directed chart review were used for data collection and analysis in this retrospective review. From September 1996, 25 patients underwent decompressive laparotomy after developing ACS. Mean burn size was 65 +/- 19% TBSA. Mean age was 28 +/- 19 years. Twenty-two (88%) died. Myo/ hemoglobinuria was present at admission in eight patients, one of whom survived. Fourteen patients had inhalation injury, of whom two survived. Before decompressive laparotomy, mean bladder pressure and peak inspiratory pressure were 57 +/- 4.2 mm Hg and 41 +/- 2.2 mm Hg, respectively. Mean urine output improved from 28 ml/hr to 90 ml/hr after decompressive laparotomy. The mean Ivy score was 443 +/- 34.95 ml/kg. Development of ACS in burn patients is associated with a high mortality. With development of IAH, therapeutic maneuvers such as sedation and paralysis, escharotomies, or changes in fluid management can be performed in hopes of altering the evolution of intra-abdominal hypertension to ACS. In patients with >40% TBSA burns, bladder pressures should initially be measured every 6 hours. When the Ivy score reaches 200 ml/kg, measure bladder pressures hourly. Decompressive laparotomies should be performed in all patients with ACS if less-invasive maneuvers fail.