ReviewFluid resuscitation in adults with severe burns at risk of secondary abdominal compartment syndrome—An evidence based systematic review☆
Section snippets
Description of the condition
Secondary abdominal compartment syndrome (sACS) in severely burnt adults is a commonly under-recognized, under-treated and rapidly fatal condition [1], [2]. Although first recognized by Wendt more than 100 years ago [3] only recently was it recognized to occur in burnt patients without abdominal trauma [2]. A consensus definition for ACS was finally formulated by Malbrain et al. as a sustained intra-abdominal pressure (IAP) ≥20 mmHg that is associated to new organ dysfunction or failure;
Literature search
An electronic search was performed across Pubmed; Cochrane Database of Systematic Reviews: ACP Journal Club, Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials; Cochrane Methodology Register; Allied and Complementary Medicine; British Nursing Index; CINAHL; EMBASE; Ovid-MEDLINE® In-Process & Other Non-Indexed Citations; The search-construct: ‘Abdominal AND compartment AND syndrome AND burns AND ((Fluid AND resuscitation) OR (monitoring))’ was used in
Management of resuscitation fluid-volume in the severely burnt adult developing secondary abdominal compartment syndrome
O’Mara et al. [7] performed a two-armed RCT on severely burnt patients comparing the effects of fluid-volume (crystalloid and colloid) on intra-abdominal pressure (IAP) and reported a causal relationship. Less volume was required in the colloid arm of their study, resulting in a lower incidence of IAH/ACS enabling colloids to be recommended in this specific scenario. Clear inclusion/exclusion criteria, baseline demographic and clinical details increase applicability of their recommendations.
Discussion
Current best evidence suggests sACS in the severely burnt adult is a common, rapidly fatal and poorly managed syndrome. Such a situation should raise concern among the burns community. Rather than accept current literature at face-value, our contribution aimed to provide an in-depth critical analysis of the robustness of the literature such that each recommendation is underscored by objectively graded evidence. Rigorously applying a hierarchy of evidence model allows an ‘explicit and judicious
Conflict of interest statement
Pertaining to all authors listed on this paper, there are no financial and personal relationships and no conflict of interest.
Acknowledgements
The authors would like to acknowledge Ms S.M. Azzopardi (University of Malta) for her contribution through detailed journal hand-searching; and Mr. Ernesto Azzopardi MPhil (Lond) Pg Dip Res Method, for cross-checking statistical analysis comments.
References (46)
- et al.
Continuous intra-abdominal pressure measurement technique
Am J Surg
(2004) - et al.
Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns
Burns
(2006) - et al.
Abdominal compartment syndrome
J Surg Educ
(2007) - et al.
Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study
Br J Anesth
(2005) Fluid volume and electrolyte changes of the early postburn period
Clin Plast Surg
(1974)Problems and complications of burn shock resuscitation
Surg Clin North Am
(1978)Uber den Einflu des intraabdominellen Druckers auf die Absonderungsgeschwindinkeit des Harnes
Arch Heilkunde
(1876)- et al.
The importance of intra-abdominal pressure measurements in burned children
J Trauma
(2004) - et al.
Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome II Recommendations
Intensive Care Med
(2007) - et al.
Intra-abdominal hypertension and abdominal compartment syndrome in burn patients
J Trauma
(2000)
A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients
J Trauma
Survey of intensive care physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome
Crit Care Med
Surveyed opinion of burns surgeons on the abdominal compartment syndrome
Abdominal compartment syndrome in patients with burns
J Burn Care Rehabil
Release of abdominal compartment syndrome improves survival in patients with burn injury
J Trauma
The importance of intra-abdominal pressure measurements in burned children
J Trauma
A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury
J Burn Care Rehabil
Intra abdominal hypertension and abdominal compartment syndrome in burns patients
J Trauma
Abdominal compartment syndrome in patients with burns
J Burns Care Rehabil
A step-by-step guide to the research process
Br J Midwifery
Cited by (52)
The First 24 Hours: Burn Shock Resuscitation and Early Complications
2023, Surgical Clinics of North AmericaPathophysiology of burn shock and burn edema
2018, Total Burn Care: Fifth EditionTRALI following fresh frozen plasma resuscitation from burn shock
2017, BurnsCitation Excerpt :In 1992, Du et al. first described using fresh frozen plasma as a means to appropriately resuscitate the patient while minimizing weight gain and edema seen with excessive fluid administration and retention [4]. A follow-up report by O’Mara et al. demonstrated that FFP could be used to successfully resuscitate severely burned patients while avoiding excessive fluid administration and the resulting weight gain, intra-abdominal hypertension and abdominal compartment syndrome that often complicates crystalloid resuscitation [5,18]. In a report from our institution, our five years of experience with FFP resuscitation in 63 patients suffering severe burns with and without documented inhalation injury supported the findings of both Du and O’Mara and revealed that excessive fluid administration could be avoided while successfully resuscitating patients from burn shock [19].
Pathophysiology of Burn Shock and Burn Edema
2017, Total Burn Care, Fifth EditionCare of the Burned Pregnant Patient
2017, Total Burn Care, Fifth Edition
- ☆
Sources of support: Ernest Azzopardi is an MSc Student at the University of Wales, Cardiff.