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

• Verfasst von: Boehm, Dorothee [VerfasserIn]
• Verfasst von: Arras, Denise [VerfasserIn]
• Verfasst von: Schröder, Christina [VerfasserIn]
• Verfasst von: Siemers, Frank [VerfasserIn]
• Verfasst von: Corterier, C. C. [VerfasserIn]
• Verfasst von: Lehnhardt, Marcus [VerfasserIn]
• Verfasst von: Dadras, Mehran [VerfasserIn]
• Verfasst von: Hartmann, Bernd [VerfasserIn]
• Verfasst von: Kuepper, Simon [VerfasserIn]
• Verfasst von: Czaja, Kay-Uwe [VerfasserIn]
• Verfasst von: Kneser, Ulrich [VerfasserIn]
• Verfasst von: Hirche, Christoph [VerfasserIn]
• Titel: Mechanical ventilation as a surrogate for diagnosing the onset of abdominal compartment syndrome (ACS) in severely burned patients (TIRIFIC-study Part II)
• Verf.angabe: 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
• E-Jahr: 2020
• Jahr: Sep 2020
• Umfang: 8 S.
• Fussnoten: Gesehen am 26.11.2020
• Titel Quelle: Enthalten in: Burns
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1974
• Jahr Quelle: 2020
• Band/Heft Quelle: 46(2020), 6, Seite 1320-1327
• ISSN Quelle: 1879-1409
• DOI: doi:10.1016/j.burns.2020.02.005
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: acs
• Sach-SW: Burn
• Sach-SW: Influencing factor
• Sach-SW: Intra-abdominal compartment syndrome
• Sach-SW: intraabdominal hypertension
• Sach-SW: Mechanical ventilation
• Sach-SW: pressure
• Sach-SW: resuscitation
• Sach-SW: Surrogate
• Sach-SW: WSACS guidelines
• K10plus-PPN: 1741230675

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. (C) 2020 Elsevier Ltd and ISBI. All rights reserved.