Fluid resuscitation in adults with severe burns at risk of secondary abdominal compartment syndrome--an evidence based systematic review.
BACKGROUND
Secondary abdominal compartment syndrome (sACS) in adults with severe burns is commonly unsuspected, can be rapidly fatal and seriously compromises the reliability of urine output as an indicator of perfusion and resuscitation status. Current literature lacks an exhaustive, evidence-based review critically appraising all retrieved literature on which clinical decisions may be based.


METHODS
The evidence on three inter-related concepts was evaluated: fluid-volume management and its contribution to sACS; the role of urinary bladder pressure monitoring; and awareness of the burns community to sACS. Literature published over the last ten years across the major databases was retrieved, and the search strategy was fully reported to reduce the retrieval bias ubiquitous in previous literature. Each article was individually appraised and classified into a framework of evidence, enabling the formulation of specific, graded recommendations.


RESULTS
Current best evidence supports recommendations to reduce fluid-volume administered through use of colloids or hypertonic saline especially if the projected resuscitation volume surpasses a 'volume ceiling'. Continuous intra-vesical monitoring is recommended: to guide fluid resuscitation for early diagnosis of sACS; and as a guide to reliability of urine output as indicator of organ perfusion. A priming volume of 75 cm(3) or less is recommended.


CONCLUSIONS
Fluid resuscitation volume is causative to sACS, especially once a predetermined maxima is reached. Continuous intra-vesical pressure monitoring is a cheap, reliable, user-friendly monitoring method recommended in high-risk patients. Poor awareness among the burns community requires urgent dissemination of evidence based information.
Azzopardi
Ernest A
EA
Department of Plastic Surgery, Plastic Surgery Unit, Wexham Park Hospital, Slough, Berkshire SL24GQ, UK. AzzopardiEA@Cardiff.ac.uk
McWilliams
Bill
B
Iyer
Srinivasan
S
Whitaker
Iain Stuart
IS
D000328:Adult; D002056:Burns / Q000150:complications / Q000628:therapy*; D003161:Compartment Syndromes / Q000175:diagnosis / Q000209:etiology*; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods