Mechanical ventilation as a surrogate for diagnosing the onset of abdominal compartment syndrome (ACS) in severely burned patients (TIRIFIC-study Part II). Issue 6 (September 2020)

• Record Type: Journal Article
• Authors: Boehm, Dorothee; Arras, Denise; Schroeder, Christina; Siemers, Frank; Corterier, C.C.; Lehnhardt, Marcus; Dadras, Mehran; Hartmann, Bernd; Kuepper, Simon; Czaja, Kay-Uwe; Kneser, Ulrich; Hirche, Christoph
• Is Part Of: Burns. Volume 46:Issue 6(2020)
• Page Start: 1320
• Page End: 1327
• Publication Date: 2020-09
• Subjects: ACS Abdominal compartment syndrome -- FRC Functional residual capacity -- IAH Intra-abdominal hypertension -- ICU Intensive care unit -- IAP Intra-abdominal pressure -- MV Mechanical ventilation -- PEEP Positive end-expiratory pressure -- TBSA Total burn surface area -- TIRIFIC-study TBSA-Independent Analysis of RIsk Factors for Intra-abdominal Compartment syndrome in burn patients -- WSACS World society of abdominal compartment syndrome; ACS -- Intra-abdominal compartment syndrome -- Mechanical ventilation -- Burn -- Surrogate -- Influencing factor -- WSACS guidelines; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2020.02.005
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Mechanical ventilation correlates with the development of abdominal compartment syndrome (ACS). High ventilation pressures in burn patients in the first four days after trauma suggest development of ACS. Increased maximum PEEP and peak pressure levels can be detected in early- and late-onset ACS-groups versus control. 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.