Abdominal compartment syndrome in traumatic hemorrhagic shock: 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.

John O. Hwabejire, Christine E. Nembhard, Tolulope A. Oyetunji, Theodros Seyoum, Suryanarayana M. Siram, Edward E. Cornwell, Wendy R. Greene*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)733-738
Number of pages6
JournalAmerican journal of surgery
Volume211
Issue number4
DOIs
StatePublished - Apr 1 2016

Keywords

  • Abdominal compartment syndrome
  • Fluid resuscitation
  • Hemorrhagic shock
  • Mortality
  • Trauma

ASJC Scopus subject areas

  • Surgery

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