TY - JOUR
T1 - Abdominal compartment syndrome in traumatic hemorrhagic shock
T2 - Is there a fluid resuscitation inflection point associated with increased risk? Presented at the 25th Annual Scientific Assembly of the Society of Black Academic Surgeons, April 9-11, 2015, Chapel Hill, North Carolina.
AU - Hwabejire, John O.
AU - Nembhard, Christine E.
AU - Oyetunji, Tolulope A.
AU - Seyoum, Theodros
AU - Siram, Suryanarayana M.
AU - Cornwell, Edward E.
AU - Greene, Wendy R.
N1 - Funding Information:
The authors would like to thank Dr Ronald G. Tompkins, the Inflammation and the Host Response to Injury investigators, and the Massachusetts General Hospital, Boston, Massachusetts for providing the data for this study. Study concept and design was done by J.O.H., C.E.N., T.A.O., T.S., S.M.S., E.E.C., and W.R.G. J.O.H. and W.R.G. helped in acquisition of data. Analysis and interpretation of data was carried out by J.O.H., C.E.N., T.A.O., T.S., S.M.S., E.E.C., and W.R.G. Drafting of the article was done by J.O.H. and W.R.G. Critical revision of the article for important intellectual content was carried out J.O.H., C.E.N., T.A.O., T.S., S.M.S., E.E.C., and W.R.G. J.O.H. done statistical analysis. Administrative, technical, and material support was given by J.O.H., C.E.N., T.A.O., T.S., and W.R.G. Study supervision was carried out by W.R.G.
Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background The volume of fluid administered during trauma resuscitation correlates with the risk of abdominal compartment syndrome (ACS). The exact volume at which this risk rises is uncertain. We established the inflection point for ACS risk during shock resuscitation. Methods Using the Glue Grant database, patients aged ≥16 years with ACS were compared with those without ACS (no-ACS). Stepwise analysis of the sum or difference of the mean total fluid volume (TV)/kg, TV and/or body weight, (μ) and standard deviations (σ) vs % ACS at each point was used to determine the fluid inflection point. Results A total of 1,976 patients were included, of which 122 (6.2%) had ACS. Compared with no-ACS, ACS patients had a higher emergency room lactate (5.8 ± 3.0 vs 4.5 ± 2.8, P <.001), international normalized ratio (1.8 ± 1.5 vs 1.4 ±.8, P <.001), and mortality (37.7% vs 14.6%, P <.001). ACS group received a higher TV/kg (498 ± 268 mL/kg vs 293 ± 171 mL/kg, P <.001) than no-ACS. The % ACS increased exponentially with the sum of μ and incremental σ, with the sharpest increase occurring at TV and/or body weight = μ + 3σ or 1,302 mL/kg. Conclusions There is a dramatic rise in ACS risk after 1,302 mL/kg of fluid is administered. This plot could serve as a guide in limiting the ACS risk during resuscitation.
AB - Background The volume of fluid administered during trauma resuscitation correlates with the risk of abdominal compartment syndrome (ACS). The exact volume at which this risk rises is uncertain. We established the inflection point for ACS risk during shock resuscitation. Methods Using the Glue Grant database, patients aged ≥16 years with ACS were compared with those without ACS (no-ACS). Stepwise analysis of the sum or difference of the mean total fluid volume (TV)/kg, TV and/or body weight, (μ) and standard deviations (σ) vs % ACS at each point was used to determine the fluid inflection point. Results A total of 1,976 patients were included, of which 122 (6.2%) had ACS. Compared with no-ACS, ACS patients had a higher emergency room lactate (5.8 ± 3.0 vs 4.5 ± 2.8, P <.001), international normalized ratio (1.8 ± 1.5 vs 1.4 ±.8, P <.001), and mortality (37.7% vs 14.6%, P <.001). ACS group received a higher TV/kg (498 ± 268 mL/kg vs 293 ± 171 mL/kg, P <.001) than no-ACS. The % ACS increased exponentially with the sum of μ and incremental σ, with the sharpest increase occurring at TV and/or body weight = μ + 3σ or 1,302 mL/kg. Conclusions There is a dramatic rise in ACS risk after 1,302 mL/kg of fluid is administered. This plot could serve as a guide in limiting the ACS risk during resuscitation.
KW - Abdominal compartment syndrome
KW - Fluid resuscitation
KW - Hemorrhagic shock
KW - Mortality
KW - Trauma
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U2 - 10.1016/j.amjsurg.2015.09.019
DO - 10.1016/j.amjsurg.2015.09.019
M3 - Article
C2 - 26941002
AN - SCOPUS:84959420920
SN - 0002-9610
VL - 211
SP - 733
EP - 738
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 4
ER -