title: Respiratory functions of burn patients undergoing decompressive laparotomy due to secondary abdominal compartment syndrome.
abstract: BACKGROUND
  The development of secondary abdominal compartment syndrome (ACS) is associated with multiple organ dysfunction. There is little information about the effects of decompressive laparotomy (DL) on respiratory function (RF) in burn patients developing ACS.
  
  
  METHODS
  We retrospectively obtained data characterising RF from the database of an adult burn intensive care unit (BICU). Peak inspiratory pressure (Pip), PaO2/FiO2-ratio (P/F), static compliance (Cstat) and airway resistance (Raw) were analysed over the course of 60 h at 8 time points relative to DL.
  
  
  RESULTS
  Thirty-five patients with ACS underwent DL with a mean percentage of total burned body surface area (TBSA) 39 ± 23% and mean intra-abdominal pressure 33 ± 7 mmHg. All patients presented with significantly deteriorating RF within 12h of DL (Pip 33 ± 4 to 39 ± 7 cm/H2O, p=0.003; P/F 232 ± 59 to 160 ± 55 mmHg, p<0.001, Cstat 34 ± 5 to 26 ± 6 mL/cmH2O, p<0.001; Raw 18 ± 3 to 24 ± 9 cm H2O/L/s, p=0.02). All these parameters improved significantly (p<0.001) after DL, regardless of the presence of inhalation injury or torso burns. Mortality was 71.4%.
  
  
  CONCLUSIONS
  Variables characterising RF demonstrated a rapid deterioration before and a significant and sustained improvement after DL in burn patients developing ACS. Despite these respiratory improvements, DL was associated with low survival rates. Secondary ACS remains a challenge in burn patients and thus warrants particular attention during intensive care treatment.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany; Department of Plastic and Hand Surgery, Burn Trauma Centre, Bergmannstrost Hospital, Halle/Saale, Germany. Electronic address: manuelstruck@web.de.
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Struck
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Reske
authors.affiliation: Department of Medical Psychology, Bergmannstrost Hospital, Halle/Saale, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Department of Anaesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital, Halle/Saale, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hilbert
authors.affiliation: Department of Plastic and Hand Surgery, Burn Trauma Centre, Bergmannstrost Hospital, Halle/Saale, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Steen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Wrigge
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance / Q000502:physiology; D001830:Body Surface Area; D002056:Burns / Q000150:complications*; D002059:Burns, Inhalation / Q000150:complications; D015331:Cohort Studies; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology; D059325:Intra-Abdominal Hypertension / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007813:Laparotomy; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Abdominal compartment syndrome; Burn; Laparotomy; Respiratory function