title: The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome.
abstract: BACKGROUND
  Anticipation of abdominal compartment syndrome (ACS) is a factor for performing damage-control laparotomy (DCL). Recent years have seen changes in resuscitation patterns and a decline in the use of DCL. We hypothesized that reductions in both crystalloid resuscitation and the use of DCL is associated with a reduced rate of ACS in trauma patients.
  
  
  METHODS
  We reviewed the records of all patients who underwent trauma laparotomies at our Level 1 trauma center over a 6-year period (2006-2011). We defined DCL as a trauma laparotomy in which the fascia was not closed at the initial operation. We defined ACS by elevated intravesical pressures and end-organ dysfunction. Our primary outcome measure was a development of ACS.
  
  
  RESULTS
  A total of 799 patients were included. We noted a significant decrease in the DCL rate (39% in 2006 vs. 8% in 2011, p < 0.001), the crystalloid volume per patient (mean [SD], 12.8 [7.8] L in 2006 vs. 6.6 [4.2] L in 2011; p < 0.001), rate of ACS (7.4% in 2006 vs. 0% in 2011, p < 0.001), and mortality rate (22.8% in 2006 vs. 10.6% in 2011, p < 0.001). However, we noted no significant changes in the mean Injury Severity Score (ISS) (p = 0.09), in the mean abdominal Abbreviated Injury Scale (AIS) score (p = 0.17), and in the mean blood product volume per patient (p = 0.67). On multivariate regression analysis, crystalloid resuscitation (p = 0.01) was the only significant factor associated with the development of ACS.
  
  
  CONCLUSIONS
  Minimizing the use of crystalloids and DCL was associated with better outcomes and virtual elimination of ACS in trauma patients. With the adaption of new resuscitation strategies, goals for a trauma laparotomy should be definitive surgical care with abdominal closure. ACS is a rare complication in the era of damage-control resuscitation and may have been iatrogenic.
  
  
  METHODS
  Epidemiologic/therapeutic study, level IV.
authors.affiliation: From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D000077324:Crystalloid Solutions; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D059325:Intra-Abdominal Hypertension / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D007552:Isotonic Solutions / Q000009:adverse effects* / Q000627:therapeutic use; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061214:Patient Safety; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions