Mechanical ventilation as a surrogate for diagnosing the onset of abdominal compartment syndrome (ACS) in severely burned patients (TIRIFIC-study Part II)

Dorothee Boehm; Denise Arras; Christina Schroeder; Frank Siemers; C C Corterier; Marcus Lehnhardt; Mehran Dadras; Bernd Hartmann; Simon Kuepper; Kay-Uwe Czaja; Ulrich Kneser; Christoph Hirche

doi:10.1016/j.burns.2020.02.005

Mechanical ventilation as a surrogate for diagnosing the onset of abdominal compartment syndrome (ACS) in severely burned patients (TIRIFIC-study Part II)

Burns. 2020 Sep;46(6):1320-1327. doi: 10.1016/j.burns.2020.02.005. Epub 2020 Feb 28.

Authors

Affiliations

¹ Dpt. of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany; Dpt. of Anesthesiology and Intensive Care, BG Trauma Center, Ludwigshafen, Germany.
² Dpt. of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany.
³ Dpt. of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Halle, Germany.
⁴ Dpt. of Plastic Surgery and Burn Center, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany.
⁵ Burn Center/Dpt. of Plastic Surgery, Trauma Hospital Berlin, Germany.
⁶ Dpt. of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany. Electronic address: christoph.hirche@bgu-ludwigshafen.de.

PMID: 32122710
DOI: 10.1016/j.burns.2020.02.005

Abstract

Intra-abdominal compartment syndrome (ACS) is a devastating complication in burn patients with a high mortality. Apart from high-volume resuscitation as known risk factor, also mechanical ventilation seems to influence the development of ACS. The TIRIFIC trial is a retrospective, matched-pair analysis. Thirty-eight burn patients with ACS were matched for burned total body surface area (TBSA), age and mechanical ventilation (MV). In contrast to the already published part I addressing fluid resuscitation as a risk factor, the parameters analyzed in part II were maximum and average PEEP and peak pressure levels as well as serum lactate levels and prokinetic therapy. For subgroup-analysis the ACS-group was split up into an early-onset and late-onset ACS-group according to the median time between burn trauma and ACS. The groups were analyzed with a two-sided Mann-Whitney-U-test with significance set at p < 0.05. In the ACS-group all ventilation pressures (maximum and average PEEP and peak pressure levels) were significantly increased compared to control. The subgroup-analysis showed significantly increased maximum PEEP and peak pressure levels in early- and late-onset ACS-groups versus control. However, the average ventilation pressure levels were only increased in the early-onset ACS-group (average PEEP p = 0.0069; average peak pressure p = 0.05). The TIRIFIC trial showed significantly increased ventilation pressures in the ACS group in general as a surrogate parameter to support early diagnostics. Especially, maximum PEEP levels and peak pressures are significantly increased in both, early- and late-onset ACS. As an addition to the actual WSACS guidelines we suggest IAP measurement in mechanically ventilated burn patients if ventilating pressures are rising continuously without a clear pulmonary or otherwise identifiable reason.

Keywords: ACS; Burn; Influencing factor; Intra-abdominal compartment syndrome; Mechanical ventilation; Surrogate; WSACS guidelines.

MeSH terms

Adolescent
Adult
Aged
Body Surface Area
Burns / therapy*
Female
Humans
Intra-Abdominal Hypertension / diagnosis
Intra-Abdominal Hypertension / epidemiology*
Male
Middle Aged
Positive-Pressure Respiration / methods*
Respiration, Artificial / methods*
Retrospective Studies
Risk Factors
Time Factors
Trauma Severity Indices
Young Adult