Intra-abdominal hypertension in the current era of modern trauma resuscitation

Background: This study aimed to determine the incidence and outcome of post-traumatic (PT) intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after the advances in haemostatic resuscitation. Methods: This is a prospective cohort study from January 2009-December 2011 involving patients with PT haemorrhagic shock. Patients' demographics, fluid resuscitation (<24h) and damage control laparotomy (DCL), morbidity and mortality were assessed. Patients were divided into group 1 (no DCL) and group 2 (DCL needed). Further, group 1 was subdivided into three subgroups (IA pressure (IAP) <12, 12-20 and >20mmHg). Results: One hundred seventeen patients enrolled in the study (102 in group 1 and 15 in group 2) with a mean age of 35 ± 14, injury severity score (ISS) of 23 ± 10, base deficit of -8.7 ± 2.7mmol/L, serum lactate of 4.6 ± 2.5mg/dL and haemoglobin level of 8.8 ± 2. Patients received 7 ± 5 red blood cell units, 6 ± 4.7 fresh frozen plasma units and 8.3 ± 3L of crystalloid per 24h. There were significant difference between the two groups regarding crystalloid volume, blood transfusion, base deficit and intensive care unit length of stay. However, mortality was higher in group 2 (20% versus 6%). IAP ≥ 20mmHg was reported in 16.7% patients, while 25.5% had IAP < 12 and 57.8% had IAP of 12-20mmHg. Patients with IAP > 20 had worse metabolic acidosis and received more blood compared with other groups. One patient died because of ACS (0.9%). Overall multiorgan failure and mortality were 5 and 7.7%, respectively. Conclusion: With current practice of minimal fluid resuscitation and liberal use of damage control strategies among trauma patients, the IAH was common transient phenomena but the incidence of ACS is remarkably low.