Outcomes of children with abdominal compartment syndrome.
BACKGROUND
Abdominal compartment syndrome (ACS) is a problem across all critical care scenarios and is associated with a high mortality. It has not been well described in pediatric populations.


OBJECTIVE
To describe the occurrence of ACS in a subset of critically ill pediatric patients and determine its effects on mortality and length of pediatric intensive care stay (PICU LOS). We also aimed to find predictors of mortality and development of ACS.


METHODS
25 bed tertiary pediatric intensive care unit.


METHODS
Patients less than 50 kg on mechanical ventilation and a urethral catheter.


METHODS
Intra-abdominal pressures (IAP) were monitored using the intra-vesical technique. ACS was defined as IAP of >12mmHg associated with new organ dysfunction or failure. Demographics, physiologic measures of organ dysfunction, PICU LOS and mortality were monitored.


RESULTS
14 (4.7%) of 294 eligible patients had ACS. Mortality was 50% among those with ACS versus 8.2% without (p<.001). PICU LOS stay did not differ between groups. No difference in mortality or PICU LOS was seen in primary versus secondaryACS or in patients who underwent abdominal decompression compared to those without decompression. IAP and ACS were independent predictors of mortality (odds ratio 1.53, 95% CI, 1.17- 1.99 and 9.09, 95% CI, 1.07 - 76.84) respectively. IAP and a PRISM score of >17 were predictive of developing ACS.


CONCLUSIONS
ACS is a clinical problem that increases the risk of mortality in critically ill children. IAP and PRISM scores may help identify children likely to develop ACS.
Ejike
J Chiaka
JC
Department of Pediatrics, School of Medicine, Loma Linda University, School of Medicine Loma Linda, California 92354, USA. jejike@ahs.llumc.edu
Humbert
S
S
Bahjri
K
K
Mathur
M
M
D000005:Abdomen / Q000503:physiopathology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000503:physiopathology* / Q000534:rehabilitation / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome