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Mechanical ventilation as a surrogate for diagnosing the onset of abdominal compartment syndrome (ACS) in severely burned patients (TIRIFIC-study Part II).

Authors
  • Boehm, Dorothee1
  • Arras, Denise2
  • Schroeder, Christina2
  • Siemers, Frank3
  • Corterier, C C3
  • Lehnhardt, Marcus4
  • Dadras, Mehran4
  • Hartmann, Bernd5
  • Kuepper, Simon5
  • Czaja, Kay-Uwe5
  • Kneser, Ulrich2
  • Hirche, Christoph6
  • 1 Dpt. of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany; Dpt. of Anesthesiology and Intensive Care, BG Trauma Center, Ludwigshafen, Germany. , (Germany)
  • 2 Dpt. of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany. , (Germany)
  • 3 Dpt. of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Halle, Germany. , (Germany)
  • 4 Dpt. of Plastic Surgery and Burn Center, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany. , (Germany)
  • 5 Burn Center/Dpt. of Plastic Surgery, Trauma Hospital Berlin, Germany. , (Germany)
  • 6 Dpt. of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany. Electronic address: [email protected] , (Germany)
Type
Published Article
Journal
Burns : journal of the International Society for Burn Injuries
Publication Date
Sep 01, 2020
Volume
46
Issue
6
Pages
1320–1327
Identifiers
DOI: 10.1016/j.burns.2020.02.005
PMID: 32122710
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Intra-abdominal compartment syndrome (ACS) is a devastating complication in burn patients with a high mortality. Apart from high-volume resuscitation as known risk factor, also mechanical ventilation seems to influence the development of ACS. The TIRIFIC trial is a retrospective, matched-pair analysis. Thirty-eight burn patients with ACS were matched for burned total body surface area (TBSA), age and mechanical ventilation (MV). In contrast to the already published part I addressing fluid resuscitation as a risk factor, the parameters analyzed in part II were maximum and average PEEP and peak pressure levels as well as serum lactate levels and prokinetic therapy. For subgroup-analysis the ACS-group was split up into an early-onset and late-onset ACS-group according to the median time between burn trauma and ACS. The groups were analyzed with a two-sided Mann-Whitney-U-test with significance set at p < 0.05. In the ACS-group all ventilation pressures (maximum and average PEEP and peak pressure levels) were significantly increased compared to control. The subgroup-analysis showed significantly increased maximum PEEP and peak pressure levels in early- and late-onset ACS-groups versus control. However, the average ventilation pressure levels were only increased in the early-onset ACS-group (average PEEP p = 0.0069; average peak pressure p = 0.05). The TIRIFIC trial showed significantly increased ventilation pressures in the ACS group in general as a surrogate parameter to support early diagnostics. Especially, maximum PEEP levels and peak pressures are significantly increased in both, early- and late-onset ACS. As an addition to the actual WSACS guidelines we suggest IAP measurement in mechanically ventilated burn patients if ventilating pressures are rising continuously without a clear pulmonary or otherwise identifiable reason. Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.

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