Issn Print: 1079-6061
Publication Date: 1999/01/01
SECONDARY ABDOMINAL COMPARTMENT SYNDROME: AN UNDER APPRECIATED MANIFESTATION OF SEVERE HEMORRHAGIC SHOCK
RA Maxwell; TC Fabian; Croce; KA Davis; Thomas J. Esposito
Excerpt
Purpose: Abdominal compartment syndrome (ACS) has been described in the surgical literature with a variety of reported etiologies. However, almost no attention has focused on ACS secondary to massive hemorrhagic shock in absence of abdominal injury. This study describes this under-appreciated form of ACS that occurs after severe hemorrhagic shock (secondary abdominal compartment syndrome, SACS) in which the inciting injuries occur remote to the abdominal cavity. Methods: The trauma registry at a level I trauma center was used to identify patients diagnosed with ACS and no intra-abdominal injury over a 13 month period beginning in July, 1997. Results: There were 1,216 ICU admissions for trauma during the study period. Five patients sustaining blunt and one patient sustaining penetrating trauma with associated hemorrhagic shock developed SACS requiring abdominal decompression with mesh in the absence of intra-abdominal injury. Average resuscitation volume prior to abdominal decompression was 19 +/- 5 liters of crystalloid and 29 +/- 10 units of packed red blood cells. Average time from admission to decompression was 17.83 +/- 9.40 hours. Decompression resulted in significant improvements in systolic blood pressure (p < .03), peak inspiratory pressure (p < .003) and base deficit (p < .003). Associated extremity compartment syndrome developed in five different extremities for a total incidence of 20%. Mortality was 67%, secondary to sepsis (3) and head injury (1). Conclusion: Little precedence has been give to ACS secondary to hemorrhagic shock when the injury site occurs remote to the abdominal cavity. This entity may occur more commonly than previously realized and early recognition may result in improved outcome in patients suffering from this condition. When resuscitation volumes approach 10 liters of crystalloid or 15 units of packed red blood cells, bladder pressures should be routinely checked and acted upon agressively. Associated extremity compartment occurred frequently and must be monitored closely in this population of patients.
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