Mechanical ventilation as a surrogate for diagnosing the onset of abdominal compartment syndrome (ACS) in severely burned patients (TIRIFIC-study Part II)
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 analys...
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| Hauptverfasser: | , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
Sep 2020
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| In: |
Burns
Year: 2020, Jahrgang: 46, Heft: 6, Pages: 1320-1327 |
| ISSN: | 1879-1409 |
| DOI: | 10.1016/j.burns.2020.02.005 |
| Online-Zugang: | Resolving-System, Volltext: https://doi.org/10.1016/j.burns.2020.02.005
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| Verfasserangaben: | Dorothee Boehm, Denise Arras, Christina Schroeder, Frank Siemers, C.C. Corterier, Marcus Lehnhardt, Mehran Dadras, Bernd Hartmann, Simon Kuepper, Kay-Uwe Czaja, Ulrich Kneser, Christoph Hirche |
| Zusammenfassung: | 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. (C) 2020 Elsevier Ltd and ISBI. All rights reserved. |
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| Beschreibung: | Gesehen am 26.11.2020 |
| Beschreibung: | Online Resource |
| ISSN: | 1879-1409 |
| DOI: | 10.1016/j.burns.2020.02.005 |