Defining intra-abdominal hypertension and abdominal compartment syndrome in acute thermal injury: a multicenter survey.
The definitions of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are not uniform despite the increasing awareness of IAH/ACS in burn patients. A short survey including definitions, resuscitation protocols, and monitoring practices was sent to every physician listed in the American Burn Association Directory. Thirty-two of 123 (26%) surveys were returned; 22 (69%) were from verified burn centers. Survey respondents said that bladder pressure indicating IAH is 19.6 mm Hg (range 12-30) and ACS is 25.9 mm Hg (range 15-40). Fifteen percentage of those responding do not include clinical sequellae in their definition of ACS. Bladder pressure is not routinely measured by 22 (69%) burn physicians, and staff at 17 centers (53%) wait until the abdomen is tense to measure abdominal pressure. Tense abdomen, along with elevated peak inspiratory pressures (PIP), is used in most centers (94%) to determine IAH/ACS, followed by oliguria (88%), and difficulty ventilating (78%). Resuscitation formulae used are primarily the Parkland/modified Parkland in 24 (75%) burn centers. Criteria for abdominal decompression is based on bladder pressures alone in 25 centers (78%); 16/32 (50%) use PIP, and 10/32 (31%) staff use other criteria including organ dysfunction or increased lactate. Eleven physicians (34%) advocate percutaneous decompression before decompressive laparotomy. Although most United States burn physicians define ACS as >or=25 mm Hg along with physiologic compromise, bladder pressure is routinely measured by only 31% of burn physicians. Most burn staff do not differentiate between IAH and ACS. Consensus definitions of IAH/ACS are necessary for burn care practitioners to compare research studies and discuss outcomes. Concise definitions will promote understanding of the pathophysiological processes involved and allow us to develop data-driven patient care protocols.
Burke
Bridget A
BA
Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52240, USA.
Latenser
Barbara A
BA
D000005:Abdomen / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D002053:Burn Units; D002056:Burns / Q000503:physiopathology* / Q000628:therapy*; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D019299:Decompression, Surgical; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005440:Fluid Therapy / Q000379:methods; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D009765:Obesity / Q000150:complications; D009846:Oliguria / Q000503:physiopathology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014481:United States; D001743:Urinary Bladder / Q000503:physiopathology; D014939:Work of Breathing / Q000502:physiology
D019344:Lactic Acid