The abdominal compartment syndrome in patients with burn injury

Abstract

Introduction: Intra-abdominal hypertension (IAH) and subsequent abdominal compartment syndrome (ACS) in burned patients is common. This sequence of events typically occurs in patients with larger burns receiving high volume fluid resuscitation.

Methods: A review of the literature was performed. The National Library of Medicine (PUBMED) was queried for "Burn" and "Abdominal Compartment Syndrome". Twenty-nine articles were retained for study.

Results: Abdominal pressure monitoring is appropriate in all patients with burns that require significant volume resuscitation (>30% total burned surface area-TBSA). Prevention of ACS in burns includes limiting fluid resuscitation, burn escharotomy, and percutaneous drainage when abdominal pressures are reaching perilous levels. Treatment includes all of the above and in addition, decompressive laparotomy when needed. However, despite decompressive laparotomy, mortality rates among burn victims with ACS remain unacceptably high.

Conclusion: Increasing amounts of volume delivery are associated with an increased risk of IAH. Therefore, intra-abdominal pressure should be monitored in all burn patients requiring massive fluid resuscitation. Escharotomy, paracentesis, and decompressive laparotomy may all be needed to counter the side effects of appropriate fluid resuscitation in the severely burned patient. Nevertheless, the prognosis in burn patients developing ACS is grim.