title: Acute lung injury and multiple organ dysfunction syndrome secondary to intra-abdominal hypertension and abdominal decompression in extensively burned patients.
abstract: BACKGROUND
  Secondary abdominal compartment syndrome (ACS) is a lethal complication after resuscitation from burn shock, even after abdominal decompression (AD) is performed. This study investigated increased susceptibility to multiple organ dysfunction syndrome (MODS) in extensively burned patients with ACS.
  
  
  METHODS
  Patients admitted to our burn unit between 2002 and 2005 with burns affecting 40% or more of the total body surface area without severe inhalation injury were analyzed. Hemodynamic parameters, blood gas analysis, and intrabladder pressure as intra-abdominal pressure were recorded. Serum interleukin (IL)-8 and IL-6 concentrations were measured in 20 of these patients. Lung injury score and Sequential Organ Failure Assessment scores were serially determined.
  
  
  RESULTS
  Fourteen of 38 patients developed intra-abdominal hypertension in 22.9 +/- 8.9 hours postburn. Hemodynamic parameters in these 14 patients, including peak intra-abdominal pressure (46.6 +/- 11.2 to 19.8 +/- 9.9 cm H2O), peak inspiratory pressure (51.4 +/- 10.5 to 31.8 +/- 7.0 cm H2O), and abdominal perfusion pressure (51.3 +/- 18.3 to 73.9 +/- 13.6 mm Hg), were improved immediately after AD. Despite AD, lung injury score and Sequential Organ Failure Assessment scores increased significantly 2 and 3 days postburn in patients who required AD. Plasma concentration of IL-8 was elevated in intra-abdominal hypertension patients 3 days postburn.
  
  
  CONCLUSIONS
  Intra-abdominal hypertension induced acute lung injury and MODS with IL-8 elevation, even though AD improved hemodynamic parameters in extensively burned patients.
authors.affiliation: Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Minami-ku, Nagoya, Japan. junoda@v001.vaio.ne.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Oda
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Yamashita
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Hideo
authors.initials: H
authors.lastname: Hosotsubo
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Aoki
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Ode
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kasai
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Noborio
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueyama
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugimoto
mesh_terms: D034841:Abdominal Cavity; D002056:Burns / Q000150:complications*; D003161:Compartment Syndromes / Q000097:blood / Q000209:etiology* / Q000601:surgery; D019299:Decompression, Surgical; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology*
chemical_list: D016209:Interleukin-8