Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure

Zsolt Balogh, Bruce A. McKinley, John B. Holcomb, Charles C. Miller, Christine S Cocanour, Rosemary A. Kozar, Alicia Valdivia, Drue N. Ware, Frederick A. Moore, Patrick Reilly, Steven R. Shackford, Dennis Wang

Research output: Contribution to journalArticle

308 Citations (Scopus)

Abstract

Background: Primary (1°) abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary (2°) ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of 1° and 2° ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion. Methods: Major torso trauma patients underwent standardized resuscitation and had prospective data collected including occurrence of ACS, demographics, ISS, urinary bladder pressure, gastric tonometry (GAPCO2 = gastric regional CO2 minus end tidal CO2), laboratory, respiratory, and hemodynamic data. With 1° and 2° ACS as endpoints, variables were tested by uni- and multivariate logistic analysis (MLA). Results: From 188 study patients during the 44-month period, 26 (14%) developed ACS - 11 (6%) were 1° ACS and 15 (8%) 2° ACS. 1° and 2° ACS had similar demographics, shock, and injury severity. Significant univariate differences included: time to decompression from ICU admit (600 ± 112 vs. 360 ± 48 min), Emergency Department (ED) crystalloid (4 ± 1 vs. 7 ± 1 L), preICU crystalloid (8 ± 1 vs. 12 ± 1L), ED blood administration (2 ± 1 vs. 6 ± 1 U), GAPCO2 (24 ± 3 vs. 36 ± 3 mmHg), requiring pelvic embolization (9 vs. 47%), and emergency operation (82% vs. 40%). Early predictors identified by MLA of 1° ACS included hemoglobin concentration, GAPCO2, temperature, and base deficit; and for 2° ACS they included crystalloid, urinary output, and GAPCO2. The areas under the receiver-operator characteristic curves calculated upon ICU admission are 1° = 0.977 and 2° = 0.983. 1° and 2° ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (1° = 13 ± 3 vs. 2° = 14 ± 3 vs. nonACS = 8 ± 2), multiple organ failure (55% vs. 53% vs. 12%), and mortality (64% vs. 53% vs. 17%). Conclusion: 1° and 2° ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2° ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.

Original languageEnglish (US)
Pages (from-to)848-861
Number of pages14
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

Fingerprint

Intra-Abdominal Hypertension
Multiple Organ Failure
Demography
Decompression
Resuscitation
Hospital Emergency Service
Stomach
Wounds and Injuries
Multivariate Analysis
Torso
Abdominal Injuries
Manometry
Mechanical Ventilators

Keywords

  • Abdominal compartment syndrome
  • Gastric tonometry
  • Intraabdominal hypertension
  • Multiple organ failure

ASJC Scopus subject areas

  • Surgery

Cite this

Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. / Balogh, Zsolt; McKinley, Bruce A.; Holcomb, John B.; Miller, Charles C.; Cocanour, Christine S; Kozar, Rosemary A.; Valdivia, Alicia; Ware, Drue N.; Moore, Frederick A.; Reilly, Patrick; Shackford, Steven R.; Wang, Dennis.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 5, 01.05.2003, p. 848-861.

Research output: Contribution to journalArticle

Balogh, Z, McKinley, BA, Holcomb, JB, Miller, CC, Cocanour, CS, Kozar, RA, Valdivia, A, Ware, DN, Moore, FA, Reilly, P, Shackford, SR & Wang, D 2003, 'Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure', Journal of Trauma - Injury, Infection and Critical Care, vol. 54, no. 5, pp. 848-861. https://doi.org/10.1097/01.TA.0000070166.29649.F3
Balogh, Zsolt ; McKinley, Bruce A. ; Holcomb, John B. ; Miller, Charles C. ; Cocanour, Christine S ; Kozar, Rosemary A. ; Valdivia, Alicia ; Ware, Drue N. ; Moore, Frederick A. ; Reilly, Patrick ; Shackford, Steven R. ; Wang, Dennis. / Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. In: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; Vol. 54, No. 5. pp. 848-861.
@article{bdb1b21c6c2f45a0a9f4843a37cbcab3,
title = "Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure",
abstract = "Background: Primary (1°) abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary (2°) ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of 1° and 2° ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion. Methods: Major torso trauma patients underwent standardized resuscitation and had prospective data collected including occurrence of ACS, demographics, ISS, urinary bladder pressure, gastric tonometry (GAPCO2 = gastric regional CO2 minus end tidal CO2), laboratory, respiratory, and hemodynamic data. With 1° and 2° ACS as endpoints, variables were tested by uni- and multivariate logistic analysis (MLA). Results: From 188 study patients during the 44-month period, 26 (14{\%}) developed ACS - 11 (6{\%}) were 1° ACS and 15 (8{\%}) 2° ACS. 1° and 2° ACS had similar demographics, shock, and injury severity. Significant univariate differences included: time to decompression from ICU admit (600 ± 112 vs. 360 ± 48 min), Emergency Department (ED) crystalloid (4 ± 1 vs. 7 ± 1 L), preICU crystalloid (8 ± 1 vs. 12 ± 1L), ED blood administration (2 ± 1 vs. 6 ± 1 U), GAPCO2 (24 ± 3 vs. 36 ± 3 mmHg), requiring pelvic embolization (9 vs. 47{\%}), and emergency operation (82{\%} vs. 40{\%}). Early predictors identified by MLA of 1° ACS included hemoglobin concentration, GAPCO2, temperature, and base deficit; and for 2° ACS they included crystalloid, urinary output, and GAPCO2. The areas under the receiver-operator characteristic curves calculated upon ICU admission are 1° = 0.977 and 2° = 0.983. 1° and 2° ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (1° = 13 ± 3 vs. 2° = 14 ± 3 vs. nonACS = 8 ± 2), multiple organ failure (55{\%} vs. 53{\%} vs. 12{\%}), and mortality (64{\%} vs. 53{\%} vs. 17{\%}). Conclusion: 1° and 2° ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2° ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.",
keywords = "Abdominal compartment syndrome, Gastric tonometry, Intraabdominal hypertension, Multiple organ failure",
author = "Zsolt Balogh and McKinley, {Bruce A.} and Holcomb, {John B.} and Miller, {Charles C.} and Cocanour, {Christine S} and Kozar, {Rosemary A.} and Alicia Valdivia and Ware, {Drue N.} and Moore, {Frederick A.} and Patrick Reilly and Shackford, {Steven R.} and Dennis Wang",
year = "2003",
month = "5",
day = "1",
doi = "10.1097/01.TA.0000070166.29649.F3",
language = "English (US)",
volume = "54",
pages = "848--861",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure

AU - Balogh, Zsolt

AU - McKinley, Bruce A.

AU - Holcomb, John B.

AU - Miller, Charles C.

AU - Cocanour, Christine S

AU - Kozar, Rosemary A.

AU - Valdivia, Alicia

AU - Ware, Drue N.

AU - Moore, Frederick A.

AU - Reilly, Patrick

AU - Shackford, Steven R.

AU - Wang, Dennis

PY - 2003/5/1

Y1 - 2003/5/1

N2 - Background: Primary (1°) abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary (2°) ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of 1° and 2° ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion. Methods: Major torso trauma patients underwent standardized resuscitation and had prospective data collected including occurrence of ACS, demographics, ISS, urinary bladder pressure, gastric tonometry (GAPCO2 = gastric regional CO2 minus end tidal CO2), laboratory, respiratory, and hemodynamic data. With 1° and 2° ACS as endpoints, variables were tested by uni- and multivariate logistic analysis (MLA). Results: From 188 study patients during the 44-month period, 26 (14%) developed ACS - 11 (6%) were 1° ACS and 15 (8%) 2° ACS. 1° and 2° ACS had similar demographics, shock, and injury severity. Significant univariate differences included: time to decompression from ICU admit (600 ± 112 vs. 360 ± 48 min), Emergency Department (ED) crystalloid (4 ± 1 vs. 7 ± 1 L), preICU crystalloid (8 ± 1 vs. 12 ± 1L), ED blood administration (2 ± 1 vs. 6 ± 1 U), GAPCO2 (24 ± 3 vs. 36 ± 3 mmHg), requiring pelvic embolization (9 vs. 47%), and emergency operation (82% vs. 40%). Early predictors identified by MLA of 1° ACS included hemoglobin concentration, GAPCO2, temperature, and base deficit; and for 2° ACS they included crystalloid, urinary output, and GAPCO2. The areas under the receiver-operator characteristic curves calculated upon ICU admission are 1° = 0.977 and 2° = 0.983. 1° and 2° ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (1° = 13 ± 3 vs. 2° = 14 ± 3 vs. nonACS = 8 ± 2), multiple organ failure (55% vs. 53% vs. 12%), and mortality (64% vs. 53% vs. 17%). Conclusion: 1° and 2° ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2° ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.

AB - Background: Primary (1°) abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary (2°) ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of 1° and 2° ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion. Methods: Major torso trauma patients underwent standardized resuscitation and had prospective data collected including occurrence of ACS, demographics, ISS, urinary bladder pressure, gastric tonometry (GAPCO2 = gastric regional CO2 minus end tidal CO2), laboratory, respiratory, and hemodynamic data. With 1° and 2° ACS as endpoints, variables were tested by uni- and multivariate logistic analysis (MLA). Results: From 188 study patients during the 44-month period, 26 (14%) developed ACS - 11 (6%) were 1° ACS and 15 (8%) 2° ACS. 1° and 2° ACS had similar demographics, shock, and injury severity. Significant univariate differences included: time to decompression from ICU admit (600 ± 112 vs. 360 ± 48 min), Emergency Department (ED) crystalloid (4 ± 1 vs. 7 ± 1 L), preICU crystalloid (8 ± 1 vs. 12 ± 1L), ED blood administration (2 ± 1 vs. 6 ± 1 U), GAPCO2 (24 ± 3 vs. 36 ± 3 mmHg), requiring pelvic embolization (9 vs. 47%), and emergency operation (82% vs. 40%). Early predictors identified by MLA of 1° ACS included hemoglobin concentration, GAPCO2, temperature, and base deficit; and for 2° ACS they included crystalloid, urinary output, and GAPCO2. The areas under the receiver-operator characteristic curves calculated upon ICU admission are 1° = 0.977 and 2° = 0.983. 1° and 2° ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (1° = 13 ± 3 vs. 2° = 14 ± 3 vs. nonACS = 8 ± 2), multiple organ failure (55% vs. 53% vs. 12%), and mortality (64% vs. 53% vs. 17%). Conclusion: 1° and 2° ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2° ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.

KW - Abdominal compartment syndrome

KW - Gastric tonometry

KW - Intraabdominal hypertension

KW - Multiple organ failure

UR - http://www.scopus.com/inward/record.url?scp=0038002761&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038002761&partnerID=8YFLogxK

U2 - 10.1097/01.TA.0000070166.29649.F3

DO - 10.1097/01.TA.0000070166.29649.F3

M3 - Article

VL - 54

SP - 848

EP - 861

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -