Document Detail


Defining intra-abdominal hypertension and abdominal compartment syndrome in acute thermal injury: a multicenter survey.
MedLine Citation:
PMID:  18535480     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The definitions of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are not uniform despite the increasing awareness of IAH/ACS in burn patients. A short survey including definitions, resuscitation protocols, and monitoring practices was sent to every physician listed in the American Burn Association Directory. Thirty-two of 123 (26%) surveys were returned; 22 (69%) were from verified burn centers. Survey respondents said that bladder pressure indicating IAH is 19.6 mm Hg (range 12-30) and ACS is 25.9 mm Hg (range 15-40). Fifteen percentage of those responding do not include clinical sequellae in their definition of ACS. Bladder pressure is not routinely measured by 22 (69%) burn physicians, and staff at 17 centers (53%) wait until the abdomen is tense to measure abdominal pressure. Tense abdomen, along with elevated peak inspiratory pressures (PIP), is used in most centers (94%) to determine IAH/ACS, followed by oliguria (88%), and difficulty ventilating (78%). Resuscitation formulae used are primarily the Parkland/modified Parkland in 24 (75%) burn centers. Criteria for abdominal decompression is based on bladder pressures alone in 25 centers (78%); 16/32 (50%) use PIP, and 10/32 (31%) staff use other criteria including organ dysfunction or increased lactate. Eleven physicians (34%) advocate percutaneous decompression before decompressive laparotomy. Although most United States burn physicians define ACS as >or=25 mm Hg along with physiologic compromise, bladder pressure is routinely measured by only 31% of burn physicians. Most burn staff do not differentiate between IAH and ACS. Consensus definitions of IAH/ACS are necessary for burn care practitioners to compare research studies and discuss outcomes. Concise definitions will promote understanding of the pathophysiological processes involved and allow us to develop data-driven patient care protocols.
Authors:
Bridget A Burke; Barbara A Latenser
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of burn care & research : official publication of the American Burn Association     Volume:  29     ISSN:  1559-047X     ISO Abbreviation:  -     Publication Date:    2008 Jul-Aug
Date Detail:
Created Date:  2008-08-18     Completed Date:  2008-11-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101262774     Medline TA:  J Burn Care Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  580-4     Citation Subset:  IM    
Affiliation:
Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52240, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdomen / blood supply,  physiopathology*,  surgery
Blood Component Transfusion / utilization
Burn Units
Burns / physiopathology*,  therapy*
Compartment Syndromes / diagnosis*,  physiopathology,  therapy
Decompression, Surgical
Enteral Nutrition / utilization
Fluid Therapy / methods
Heart Failure / physiopathology
Humans
Lactic Acid / blood
Obesity / complications
Oliguria / physiopathology
Physician's Practice Patterns / statistics & numerical data*
Questionnaires
Respiration, Artificial
Respiratory Insufficiency / physiopathology
United States
Urinary Bladder / physiopathology
Work of Breathing / physiology
Chemical
Reg. No./Substance:
50-21-5/Lactic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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