title: Secondary abdominal compartment syndrome in patients with toxic epidermal necrolysis.
abstract: BACKGROUND
  Secondary abdominal compartment syndrome (ACS) is a severe complication in patients admitted to burn intensive care units (BICUs). Unlike patients with thermal burns, patients with toxic epidermal necrolysis (TEN) present with a different pathophysiology and usually require less fluid.
  
  
  METHODS
  We reviewed our registry of adult patients presenting with TEN in our 8-bed BICU over the course of 11 years and identified and analyzed patients treated for ACS and decompressive laparotomy (DL).
  
  
  RESULTS
  From a total of 29 patients with bioptic confirmed TEN, 5 underwent DL due to ACS with a mean age of 57 years, mean percentage of total body surface area (TBSA) affected of 54±25%, complete epidermolysis of 28±24% TBSA, a mean severity of illness score (SCORTEN) of 3.8±0.8, and a mean intra-abdominal pressure before DL of 33±7 mmHg. Mortality was 100% in patients with ACS versus 33% without ACS.
  
  
  CONCLUSIONS
  An ACS that requires DL worsens the already critical condition of a TEN patient considerably. TEN-related impaired intestinal functionality and increasing intestinal edema due to systemic capillary leakage warrant early initiation of intra-abdominal pressure monitoring to identify patients at high risk of ACS.
authors.affiliation: Department of Plastic and Hand Surgery, Burn Trauma Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112 Halle/Saale, Germany. manuelstruck@web.de
authors.forename: Manuel Florian
authors.initials: MF
authors.lastname: Struck
authors.forename: Till
authors.initials: T
authors.lastname: Illert
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.forename: Beate
authors.initials: B
authors.lastname: Reichelt
authors.forename: Michael
authors.initials: M
authors.lastname: Steen
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D002056:Burns / Q000150:complications*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012307:Risk Factors; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000401:mortality