The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome

Bellal Joseph, Bardiya Zangbar, Viraj Pandit, Gary Vercruysse, Hassan Aziz, Narong Kulvatunyou, Julie Wynne, Terence OKeeffe, Andrew Tang, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

24 Scopus citations

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. LEVEL OF EVIDENCE: Epidemiologic/therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)457-461
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

Keywords

  • Damage-control laparotomy
  • abdominal compartment syndrome
  • crystalloid resuscitation
  • damagecontrol resuscitation
  • trauma laparotomy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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