Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure.
BACKGROUND
Primary abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of primary and secondary ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion.


METHODS
Major torso trauma patients underwent standardized resuscitation and had prospective data collected including occurrence of ACS, demographics, ISS, urinary bladder pressure, gastric tonometry (GAP(CO2) = gastric regional CO(2) minus end tidal CO(2)), laboratory, respiratory, and hemodynamic data. With primary and secondary ACS as endpoints, variables were tested by uni- and multivariate logistic analysis (MLA).


RESULTS
From 188 study patients during the 44-month period, 26 (14%) developed ACS-11 (6%) were primary ACS and 15 (8%) secondary ACS. Primary and secondary ACS had similar demographics, shock, and injury severity. Significant univariate differences included: time to decompression from ICU admit (600 +/- 112 vs. 360 +/- 48 min), Emergency Department (ED) crystalloid (4 +/- 1 vs. 7 +/- 1 L), preICU crystalloid (8 +/- 1 vs. 12 +/- 1L), ED blood administration (2 +/- 1 vs. 6 +/- 1 U), GAP(CO2) (24 +/- 3 vs. 36 +/- 3 mmHg), requiring pelvic embolization (9 vs. 47%), and emergency operation (82% vs. 40%). Early predictors identified by MLA of primary ACS included hemoglobin concentration, GAP(CO2), temperature, and base deficit; and for secondary ACS they included crystalloid, urinary output, and GAP(CO2). The areas under the receiver-operator characteristic curves calculated upon ICU admission are primary= 0.977 and secondary= 0.983. Primary and secondary ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (primary= 13 +/- 3 vs. secondary= 14 +/- 3 vs. nonACS = 8 +/- 2), multiple organ failure (55% vs. 53% vs. 12%), and mortality (64% vs. 53% vs. 17%).


CONCLUSIONS
Primary and secondary ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2 degrees ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.
Balogh
Zsolt
Z
Department of Surgery, Memorial Hermann Hospital, University of Texas at Houston Medical School, 77030, USA.
McKinley
Bruce A
BA
Holcomb
John B
JB
Miller
Charles C
CC
Cocanour
Christine S
CS
Kozar
Rosemary A
RA
Valdivia
Alicia
A
Ware
Drue N
DN
Moore
Frederick A
FA
D000005:Abdomen / Q000502:physiology; D000007:Abdominal Injuries / Q000145:classification / Q000150:complications*; D000328:Adult; D000704:Analysis of Variance; D003161:Compartment Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000077324:Crystalloid Solutions; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015994:Incidence; D007552:Isotonic Solutions; D016015:Logistic Models; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology*; D009104:Multiple Trauma / Q000145:classification / Q000150:complications* / Q000401:mortality / Q000628:therapy; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000627:therapeutic use; D011312:Pressure; D011379:Prognosis; D012372:ROC Curve; D012151:Resuscitation / Q000009:adverse effects; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000628:therapy; D013898:Thoracic Injuries / Q000150:complications; D015599:Trauma Severity Indices
D000077324:Crystalloid Solutions; D006454:Hemoglobins; D007552:Isotonic Solutions; D010952:Plasma Substitutes