Secondary abdominal compartment syndrome in a case of pediatric trauma shock resuscitation

IntroductionSevere bleeding after trauma frequently results in poor outcomes in children. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed, through a retrospective analysis of matched pairs, to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured children.MethodsThe data for 67,782 patients from the TraumaRegister DGU® of the German Trauma Society were analyzed. The following inclusion criteria were applied: injury severity score ≥16 points, primary admission, age 1 to 15 years old, systolic blood pressure ≥20 mmHg at the accident site and transfusion of at least one unit of packed red blood cells (pRBC) in the emergency trauma room prior to intensive care admission. As volume replacement therapy depends on age and body weight, especially in children, three subgroups were formed according to the mean value of the administered prehospital volume. The children were matched and enrolled into two groups according to the following criteria: intubation at the accident site (yes/no), Abbreviated Injury Scale (four body regions), accident year, systolic blood pressure and age group.ResultsA total of 31 patients in each group met the inclusion criteria. An increase in volume replacement was associated with an elevated need for a transfusion (≥10 pRBC: low volume, 9.7%; high volume, 25.8%; P = 0.18) and a reduction in the ability to coagulate (prothrombin time ratio: low volume, 58.7%; high volume, 55.6%; P = 0.23; prothrombin time: low volume, 42.2 seconds; high volume, 50.1 seconds; P = 0.38). With increasing volume, the mortality (low volume, 19.4%; high volume, 25.8%; P = 0.75) and multiple organ failure rates (group 1, 36.7%; group 2, 41.4%; P = 0.79) increased. With increased volume, the rescue time also increased (low volume, 62 minutes; high volume, 71.5 minutes; P = 0.21).ConclusionFor the first time, a tendency was shown that excessive prehospital fluid replacement in children leads to a worse clinical course with higher mortality and that excessive fluid replacement has a negative influence on the ability to coagulate.

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“…One case report described the formation of abdominal compartment syndrome after extensive volume replacement therapy [17]. …”

Section: Introductionmentioning

confidence: 99%

Influence of prehospital volume replacement on outcome in polytraumatized children

Hussmann

Lefering²,

Kauther

et al. 2012

Crit Care

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“…In this VLBW neonate, the appropriate, aggressive resuscitation resulted in the development of ACS, which has been seen in other cases. 14,[20][21][22] In patients with developing ACS, continued aggressive volume loading may actually hasten its occurrence, and decreasing response to fluid boluses in the setting of worsening respiratory parameters, abdominal distention, and worsening oliguria may be the hallmark of impending fulminant ACS. 21,23 This diagnosis requires a high level of suspicion, and whereas the awareness of this syndrome has increased in recent years, there is still a great deal of variation among critical care physicians when it comes to recognizing and/or monitoring for ACS.…”

Section: Case Reportmentioning

confidence: 98%

“…14,[20][21][22] In patients with developing ACS, continued aggressive volume loading may actually hasten its occurrence, and decreasing response to fluid boluses in the setting of worsening respiratory parameters, abdominal distention, and worsening oliguria may be the hallmark of impending fulminant ACS. 21,23 This diagnosis requires a high level of suspicion, and whereas the awareness of this syndrome has increased in recent years, there is still a great deal of variation among critical care physicians when it comes to recognizing and/or monitoring for ACS. 1,12,18,[24][25][26] Vigilant monitoring has been recommended for at-risk patients due to current disparities in awareness and the grave consequences of delayed recognition and treatment.…”

Section: Case Reportmentioning

confidence: 98%

Management of Abdominal Compartment Syndrome in a Very Low Birth Weight Neonate Using Penrose Drains and Subsequent Management of Abdominal-Wall Defects

Rasner

Parrott

Tekulve

et al. 2008

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Rapid fluid administration, together with reperfusion injury and activation of inflammatory mediators, leads to increased capillary permeability and an increased risk of developing IAH and ACS [120,121]. There are seven prospective studies investigating the relationship between intravenous fluids and IAH in 1329 trauma patients [47][48][49][50][51][52]74], fourteen retrospective studies in 4233 trauma patients [38,39,[53][54][55][56][57][58][59][60][61][62]69,75], five case reports [63][64][65][66]73], and five case reports in children [37,67,68,70,71] (Supplementary Table S3).…”

Section: Trauma Patientsmentioning

confidence: 99%

Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review

Jacobs

Wise

Myatchin

et al. 2022

Life

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Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS). Methods: We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH. Results: We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality. Conclusions: Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial.

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Secondary abdominal compartment syndrome in a case of pediatric trauma shock resuscitation

Cited by 14 publications

References 30 publications

Influence of prehospital volume replacement on outcome in polytraumatized children

Influence of prehospital volume replacement on outcome in polytraumatized children

Management of Abdominal Compartment Syndrome in a Very Low Birth Weight Neonate Using Penrose Drains and Subsequent Management of Abdominal-Wall Defects

Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review

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