title: Intra-abdominal hypertension in the current era of modern trauma resuscitation.
abstract: BACKGROUND
  This study aimed to determine the incidence and outcome of post-traumatic (PT) intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after the advances in haemostatic resuscitation.
  
  
  METHODS
  This is a prospective cohort study from January 2009-December 2011 involving patients with PT haemorrhagic shock. Patients' demographics, fluid resuscitation (<24 h) and damage control laparotomy (DCL), morbidity and mortality were assessed. Patients were divided into group 1 (no DCL) and group 2 (DCL needed). Further, group 1 was subdivided into three subgroups (IA pressure (IAP) <12, 12-20 and >20 mmHg).
  
  
  RESULTS
  One hundred seventeen patients enrolled in the study (102 in group 1 and 15 in group 2) with a mean age of 35 ± 14, injury severity score (ISS) of 23 ± 10, base deficit of -8.7 ± 2.7 mmol/L, serum lactate of 4.6 ± 2.5 mg/dL and haemoglobin level of 8.8 ± 2. Patients received 7 ± 5 red blood cell units, 6 ± 4.7 fresh frozen plasma units and 8.3 ± 3 L of crystalloid per 24 h. There were significant difference between the two groups regarding crystalloid volume, blood transfusion, base deficit and intensive care unit length of stay. However, mortality was higher in group 2 (20% versus 6%). IAP ≥ 20 mmHg was reported in 16.7% patients, while 25.5% had IAP < 12 and 57.8% had IAP of 12-20 mmHg. Patients with IAP > 20 had worse metabolic acidosis and received more blood compared with other groups. One patient died because of ACS (0.9%). Overall multiorgan failure and mortality were 5 and 7.7%, respectively.
  
  
  CONCLUSIONS
  With current practice of minimal fluid resuscitation and liberal use of damage control strategies among trauma patients, the IAH was common transient phenomena but the incidence of ACS is remarkably low.
authors.affiliation: Trauma Intensive Care Unit, Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: Ismail
authors.initials: I
authors.lastname: Mahmood
authors.forename: Saeed
authors.initials: S
authors.lastname: Mahmood
authors.forename: Ashok
authors.initials: A
authors.lastname: Parchani
authors.forename: Suresh
authors.initials: S
authors.lastname: Kumar
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zarour
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology* / Q000628:therapy*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D015994:Incidence; D059325:Intra-Abdominal Hypertension / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation; D016896:Treatment Outcome
keywords: abdominal compartment syndrome; intra-abdominal hypertension