A systematic review on intra-abdominal pressure in severely burned patients

Steven G Strang; Esther M M Van Lieshout; Roelf S Breederveld; Oscar J F Van Waes

doi:10.1016/j.burns.2013.07.001

A systematic review on intra-abdominal pressure in severely burned patients

Burns. 2014 Feb;40(1):9-16. doi: 10.1016/j.burns.2013.07.001. Epub 2013 Sep 17.

Authors

Steven G Strang¹, Esther M M Van Lieshout¹, Roelf S Breederveld², Oscar J F Van Waes³

Affiliations

¹ Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, Rotterdam, The Netherlands.
² Red Cross Hospital, Burn Unit, Beverwijk, The Netherlands.
³ Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, Rotterdam, The Netherlands. Electronic address: o.vanwaes@erasmusmc.nl.

PMID: 24050978
DOI: 10.1016/j.burns.2013.07.001

Abstract

Objective: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are complications that may occur in severely burned patients. Evidenced based medicine for these patients is in its early development. The aim of this study was to provide an overview of literature regarding IAH and ACS in severely burned patients.

Methods: A systematic search was performed in Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science and CINAHL on October 1, 2012. These databases were searched on 'burn', 'intra-abdominal hypertension', 'abdominal compartment syndrome', synonyms and abbreviations. Studies reporting original data on mortality, abdominal decompression or abdominal pressure related complications were included.

Results: Fifty publications met the criteria, reporting 1616 patients. The prevalence of ACS and IAH in severely burned patients is 4.1-16.6% and 64.7-74.5%, respectively. The mean mortality rate for ACS in burn patients is 74.8%. The use of plasma and hypertonic lactated resuscitation may prevent IAH or ACS. Despite colloids decrease resuscitation volume needs, no benefit in preventing IAH was proven. Escharotomy, peritoneal catheter drainage, and decompression laparotomy are effective intra-abdominal pressure (IAP) diminishing treatments in burn patients. Markers for IAP-related organ damage might be superior to IAP measurement itself.

Conclusion: ACS and IAH are frequently seen devastating complications in already severely injured burn patients. Prevention is challenging but can be achieved by improving fluid resuscitation strategies. Surgical decompression measures are effective and often unavoidable. Timing is essential since decompression should prevent progression to ACS rather than limit its effects. Prognosis of ACS remains poor, but options for care improvement are available in literature.

Keywords: Abdominal compartment syndrome; Burn; Intra-abdominal hypertension; Intra-abdominal pressure.

Publication types

Review
Systematic Review

MeSH terms

Burns / complications*
Decompression, Surgical
Humans
Intra-Abdominal Hypertension / etiology*
Intra-Abdominal Hypertension / mortality
Intra-Abdominal Hypertension / surgery
Severity of Illness Index