Journal article
The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome
The journal of trauma and acute care surgery, Vol.76(2), pp.457-461
02/01/2014
DOI: 10.1097/TA.0b013e3182a9ea44
PMID: 24398772
Abstract
BACKGROUND: Anticipation of abdominal compartment syndrome (ACS) is a factor for performing damage-control laparotomy (DCL). Recent years have seen changes in resuscitation patterns and a decline in the use of DCL. We hypothesized that reductions in both crystalloid resuscitation and the use of DCL is associated with a reduced rate of ACS in trauma patients.
METHODS: We reviewed the records of all patients who underwent trauma laparotomies at our Level 1 trauma center over a 6-year period (2006-2011). We defined DCL as a trauma laparotomy in which the fascia was not closed at the initial operation. We defined ACS by elevated intravesical pressures and end-organ dysfunction. Our primary outcome measure was a development of ACS.
RESULTS: A total of 799 patients were included. We noted a significant decrease in the DCL rate (39% in 2006 vs. 8% in 2011, p < 0.001), the crystalloid volume per patient (mean [SD], 12.8 [7.8] L in 2006 vs. 6.6 [4.2] L in 2011; p < 0.001), rate of ACS (7.4% in 2006 vs. 0% in 2011, p < 0.001), and mortality rate (22.8% in 2006 vs. 10.6% in 2011, p < 0.001). However, we noted no significant changes in the mean Injury Severity Score (ISS) (p = 0.09), in the mean abdominal Abbreviated Injury Scale (AIS) score (p = 0.17), and in the mean blood product volume per patient (p = 0.67). On multivariate regression analysis, crystalloid resuscitation (p = 0.01) was the only significant factor associated with the development of ACS.
CONCLUSION: Minimizing the use of crystalloids and DCL was associated with better outcomes and virtual elimination of ACS in trauma patients. With the adaption of new resuscitation strategies, goals for a trauma laparotomy should be definitive surgical care with abdominal closure. ACS is a rare complication in the era of damage-control resuscitation and may have been iatrogenic. (C) 2014 by Lippincott Williams & Wilkins
Details
- Title: Subtitle
- The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome
- Creators
- Bellal Joseph - University of ArizonaBardiya Zangbar - University of ArizonaViraj Pandit - University of ArizonaGary Vercruysse - University of ArizonaHassan Aziz - University of ArizonaNarong Kulvatunyou - University of ArizonaJulie Wynne - University of ArizonaTerence O'Keeffe - University of ArizonaAndrew Tang - University of ArizonaRandall S. Friese - University of ArizonaPeter Rhee - University of Arizona
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.76(2), pp.457-461
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/TA.0b013e3182a9ea44
- PMID
- 24398772
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Number of pages
- 5
- Language
- English
- Date published
- 02/01/2014
- Academic Unit
- Surgery
- Record Identifier
- 9984701657302771
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