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01.12.2014 | Research | Ausgabe 1/2014 Open Access

Journal of Trauma Management & Outcomes 1/2014

A necessary evil? Intra-abdominal hypertension complicating burn patient resuscitation

Zeitschrift:
Journal of Trauma Management & Outcomes > Ausgabe 1/2014
Autoren:
Paul B McBeth, Kim Sass, Duncan Nickerson, Chad G Ball, Andrew W Kirkpatrick
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-2897-8-12) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that there is no actual or potential conflict of interest in relation to this article.

Authors’ contributions

PBM and AWK drafted the manuscript. PBM, KS, DN and CGB contributed to acquisition of data, analysis and interpretation of data. AWK, CGB and DN participated in conception, design and coordination, and supervised the whole study. All authors read and approved the final manuscript.

Abstract

Objective

Severe burns are devastating injuries that result in considerable systemic inflammation and often require resuscitation with large volumes of fluid. The result of massive resuscitation is often raised intra-abdominal pressures leading to Intra-abdominal hypertension (IAH) and the secondary abdominal compartment syndrome. The objective of this study is to conduct (1) a 10 year retrospective study to investigate epidemiological factors contributing to burn injuries in Alberta, (2) to characterize fluid management and incidence of IAH and ACS and (3) to review fluid resuscitation with a goal to identify optimal strategies for fluid resuscitation.

Design

A comprehensive 10-year retrospective review of burn injuries from 1999.

Outcome Measures

Age, sex, date, mechanism of injury, location of incident, on scene vitals and GCS, type of transport to hospital and routing, ISS, presenting vitals and GCS, diagnoses, procedures, complications, hospital LOS, ICU LOS, and events surrounding the injury.

Results

One hundred and seventy five patients (79.4% M, 20.6% F) were identified as having traumatic burn injuries with a mean ISS score of 21.8 (±8.3). The mean age was 41.6 (±17.5) (range 14-94) years. Nearly half (49.7%) of patients suffered their injuries at home, 17.7% were related to industrial incidents and 14.3% were MVC related. One hundred and ten patients required ICU admission. ICU LOS 18.5 (±8.8) days. Hospital LOS 38.0 (±37.8) days. The mean extent of burn injury was 31.4 (±20.9) % TBSA. Nearly half of the patients suffered inhalational injuries (mild 12.5%, moderate 13.7%, severe 9.1%). Thirty-nine (22.2%) of patients died from their injuries. Routine IAP monitoring began in September, 2005 with 15 of 28 patients having at least two IAP measurements. The mean IAP was 16.5 (±5.7) cm H2O (range: 1-40) with an average of 58 (±97) IAP measurements per patient. Those patients with IAP monitoring had an average TBSA of 35.0 (±16.0)%, ISS of 47.5 (±7.5). The mean 48 hr fluid balance was 25.6 (±11.1)L exceeding predicted Parkland formula estimates by 86 (±32)%.

Conclusions

Further evaluation of IAP monitoring is needed to further characterize IAP and fluid resuscitation in patients with burn injuries.
Zusatzmaterial
Authors’ original file for figure 1
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Authors’ original file for figure 2
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Authors’ original file for figure 3
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Authors’ original file for figure 4
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Authors’ original file for figure 5
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Literatur
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Reviewer Acknowledgement

Reviewer acknowledgement 2013