title: Decompressive laparotomy for abdominal compartment syndrome.
abstract: BACKGROUND
  The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes.
  
  
  METHODS
  This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28-day and 1-year all-cause mortality. Changes in intra-abdominal pressure (IAP) and organ function, and laparotomy-related morbidity were secondary endpoints.
  
  
  RESULTS
  Thirty-three patients were included in the study (20 men). Twenty-seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20-32). Median IAP was 23 (21-27) mmHg before decompressive laparotomy, decreasing to 12 (9-15), 13 (8-17), 12 (9-15) and 12 (9-14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non-survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28-day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non-survivors were no different from survivors, except that they tended to be older and on mechanical ventilation.
  
  
  CONCLUSIONS
  Decompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome.
authors.affiliation: Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: J J
authors.initials: JJ
authors.lastname: De Waele
authors.affiliation: Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
authors.forename: E
authors.initials: E
authors.lastname: Kimball
authors.affiliation: Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerp, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Malbrain
authors.affiliation: Anaesthesia and Critical Care, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: I
authors.initials: I
authors.lastname: Nesbitt
authors.affiliation: General Intensive Care Unit, Rabin Medical Centre, Petah Tikva, and Critical Care and Anaesthesia, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Anaesthesiology, Emergency Medicine and Critical Care, Tbilisi State Medical University Central Clinic, Tbilisi, Georgia.
authors.forename: V
authors.initials: V
authors.lastname: Kaloiani
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ivatury
authors.affiliation: Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
authors.forename: M
authors.initials: M
authors.lastname: Mone
authors.affiliation: Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.|Artevelde University College, Ghent, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Debergh
authors.affiliation: Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Björck
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000401:mortality / Q000601:surgery*; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome