Intra-abdominal hypertension and abdominal compartment syndrome in burn patients.
BACKGROUND
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are known to occur in patients after major abdominal surgery. The incidence of IAH and ACS in the burn population is not known.


METHODS
We prospectively recorded the intra-abdominal pressures of major burn patients admitted to our burn center from February 1999 to September 1999. A bladder pressure greater than 25 mm Hg was diagnosed as IAH. ACS was diagnosed when pulmonary compliance decreased in association with persistent IAH and was treated with abdominal decompression.


RESULTS
Ten patients were placed on the protocol; of these, seven developed IAH. Five responded to conservative treatment. Two patients with 80% body surface area burns developed ACS and required decompression.


CONCLUSIONS
IAH occurs commonly in major burn patients, and ACS is seen regularly in patients with more than 70% body surface area burns. We recommend bladder pressure measurements after infusion of more than 0.25 L/kg during the acute resuscitation phase and for peak inspiratory pressures greater than 40 cm H2O. Whereas ACS warrants surgical decompression of the abdominal cavity, IAH usually responds to conservative therapy.
Ivy
M E
ME
Bridgeport Hospital, New Haven, Connecticut 06610, USA. pmivy@bpthosp.org
Atweh
N A
NA
Palmer
J
J
Possenti
P P
PP
Pineau
M
M
D'Aiuto
M
M
D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications / Q000628:therapy*; D003161:Compartment Syndromes / Q000209:etiology* / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012151:Resuscitation; D001743:Urinary Bladder / Q000503:physiopathology