Acute lung injury and multiple organ dysfunction syndrome secondary to intra-abdominal hypertension and abdominal decompression in extensively burned patients.
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.
Oda
Jun
J
Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Minami-ku, Nagoya, Japan. junoda@v001.vaio.ne.jp
Yamashita
Katsuyuki
K
Inoue
Takuya
T
Hosotsubo
Hideo
H
Aoki
Yoshiki
Y
Ode
Yasumasa
Y
Kasai
Kosuke
K
Noborio
Mitsuhiro
M
Ueyama
Masashi
M
Sugimoto
Hisashi
H
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*
D016209:Interleukin-8