Negative fluid balance in patients with abdominal compartment syndrome--case reports.
Abdominal compartment syndrome (ACS) is defined as a sustained increase of intra-abdominal pressure (IAP) above 20 mmHg followed by the development of organ dysfunction. Treatment of ACS is still a question to be discussed and surgical decompression is usually preferred. According to recent data, massive crystalloid resuscitation of shock plays a key role in the development of secondary ACS in trauma patients. As mentioned previously, a high volume of infused crystalloids and a positive fluid balance were associated with ACS development in trauma patients as well as in septic patients. Moreover, we observed that a treatment strategy based on the achievement of a negative fluid balance resulted in a dramatic decrease in IAP and an improvement in haemodynamics and ventilation. This approach has been indicated as an interesting option for non-surgical treatment, with a caution that such intervention may exacerbate gut hypoperfusion. In this report we present two patients with secondary ACS development following abdominal surgery in which the achievement of a negative fluid balance showed a similar effect. Moreover, the fluid removal procedure also seemed to be associated with an improvement in splanchnic perfusion, as measured by gastric tonometry.
Kula
R
R
University Hospital Ostrava, Department of Anaesthesiology and Intensive Care, Ostrava, Czech Republic. roman.kula@fnspo.cz
Szturz
P
P
Sklienka
P
P
Neiser
J
J
D000005:Abdomen; D000328:Adult; D000368:Aged; D003161:Compartment Syndromes / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008991:Monitoring, Physiologic; D011312:Pressure; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions