title: Abdominal compartment syndrome in traumatic hemorrhagic shock: is there a fluid resuscitation inflection point associated with increased risk?
abstract: BACKGROUND
  The volume of fluid administered during trauma resuscitation correlates with the risk of abdominal compartment syndrome (ACS). The exact volume at which this risk rises is uncertain. We established the inflection point for ACS risk during shock resuscitation.
  
  
  METHODS
  Using the Glue Grant database, patients aged ≥16 years with ACS were compared with those without ACS (no-ACS). Stepwise analysis of the sum or difference of the mean total fluid volume (TV)/kg, TV and/or body weight, (μ) and standard deviations (σ) vs % ACS at each point was used to determine the fluid inflection point.
  
  
  RESULTS
  A total of 1,976 patients were included, of which 122 (6.2%) had ACS. Compared with no-ACS, ACS patients had a higher emergency room lactate (5.8 ± 3.0 vs 4.5 ± 2.8, P < .001), international normalized ratio (1.8 ± 1.5 vs 1.4 ± .8, P < .001), and mortality (37.7% vs 14.6%, P < .001). ACS group received a higher TV/kg (498 ± 268 mL/kg vs 293 ± 171 mL/kg, P < .001) than no-ACS. The % ACS increased exponentially with the sum of μ and incremental σ, with the sharpest increase occurring at TV and/or body weight = μ + 3σ or 1,302 mL/kg.
  
  
  CONCLUSIONS
  There is a dramatic rise in ACS risk after 1,302 mL/kg of fluid is administered. This plot could serve as a guide in limiting the ACS risk during resuscitation.
authors.affiliation: Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
authors.forename: John O
authors.initials: JO
authors.lastname: Hwabejire
authors.affiliation: Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Nembhard
authors.affiliation: Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.affiliation: Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
authors.forename: Theodros
authors.initials: T
authors.lastname: Seyoum
authors.affiliation: Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
authors.forename: Suryanarayana M
authors.initials: SM
authors.lastname: Siram
authors.affiliation: Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.affiliation: Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA. Electronic address: wgreene@howard.edu.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Greene
mesh_terms: D000005:Abdomen; D000328:Adult; D003161:Compartment Syndromes / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D015601:Injury Severity Score; D019934:International Normalized Ratio; D007773:Lactates / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality / Q000628:therapy*
chemical_list: D007773:Lactates
keywords: Abdominal compartment syndrome; Fluid resuscitation; Hemorrhagic shock; Mortality; Trauma