Document Detail


Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure.
MedLine Citation:
PMID:  12777898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Primary abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of primary and secondary ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion. METHODS: Major torso trauma patients underwent standardized resuscitation and had prospective data collected including occurrence of ACS, demographics, ISS, urinary bladder pressure, gastric tonometry (GAP(CO2) = gastric regional CO(2) minus end tidal CO(2)), laboratory, respiratory, and hemodynamic data. With primary and secondary ACS as endpoints, variables were tested by uni- and multivariate logistic analysis (MLA). RESULTS: From 188 study patients during the 44-month period, 26 (14%) developed ACS-11 (6%) were primary ACS and 15 (8%) secondary ACS. Primary and secondary ACS had similar demographics, shock, and injury severity. Significant univariate differences included: time to decompression from ICU admit (600 +/- 112 vs. 360 +/- 48 min), Emergency Department (ED) crystalloid (4 +/- 1 vs. 7 +/- 1 L), preICU crystalloid (8 +/- 1 vs. 12 +/- 1L), ED blood administration (2 +/- 1 vs. 6 +/- 1 U), GAP(CO2) (24 +/- 3 vs. 36 +/- 3 mmHg), requiring pelvic embolization (9 vs. 47%), and emergency operation (82% vs. 40%). Early predictors identified by MLA of primary ACS included hemoglobin concentration, GAP(CO2), temperature, and base deficit; and for secondary ACS they included crystalloid, urinary output, and GAP(CO2). The areas under the receiver-operator characteristic curves calculated upon ICU admission are primary= 0.977 and secondary= 0.983. Primary and secondary ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (primary= 13 +/- 3 vs. secondary= 14 +/- 3 vs. nonACS = 8 +/- 2), multiple organ failure (55% vs. 53% vs. 12%), and mortality (64% vs. 53% vs. 17%). CONCLUSION: Primary and secondary ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2 degrees ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.
Authors:
Zsolt Balogh; Bruce A McKinley; John B Holcomb; Charles C Miller; Christine S Cocanour; Rosemary A Kozar; Alicia Valdivia; Drue N Ware; Frederick A Moore
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of trauma     Volume:  54     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-06-02     Completed Date:  2003-06-19     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  848-59; discussion 859-61     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Memorial Hermann Hospital, University of Texas at Houston Medical School, 77030, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdomen / physiology
Abdominal Injuries / classification,  complications*
Adult
Analysis of Variance
Compartment Syndromes / diagnosis,  epidemiology,  etiology*
Erythrocyte Transfusion
Female
Hemoglobins / analysis
Humans
Incidence
Isotonic Solutions
Logistic Models
Male
Multiple Organ Failure / etiology*
Multiple Trauma / classification,  complications*,  mortality,  therapy
Plasma Substitutes / administration & dosage*,  therapeutic use
Pressure
Prognosis
ROC Curve
Resuscitation / adverse effects
Risk Factors
Shock, Hemorrhagic / therapy
Thoracic Injuries / complications
Trauma Severity Indices
Grant Support
ID/Acronym/Agency:
P50 GM38529-11/GM/NIGMS NIH HHS; U54 GM62219-01A1/GM/NIGMS NIH HHS
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Isotonic Solutions; 0/Plasma Substitutes; 0/crystalloid solutions
Comments/Corrections
Comment In:
J Trauma. 2003 Nov;55(5):1004; author reply 1004-5   [PMID:  14608188 ]

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