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Intraabdominal pressure in critical burn patients
Critical Care volume 19, Article number: P386 (2015)
The aim was to study the evolution and incidence of intraabdominal hypertension in critical burn patients using a slightly restrictive fluid therapy protocol based on monitoring transpulmonary thermodilution and lactic acid.
A prospective study of 132 consecutive patients admitted to the Critical Burn Unit between October 2008 and October 2011. In all of them resuscitation was performed by objectives: blood pressure (>65 mmHg), hourly diuresis (0.5 to 1 cm3/kg), lactic acid clearance and thermodilution transpulmonary parameters (CI >2.5 l/minute/m2, ITBI: 600 ml/m2). We performed measurements of IAP with a bladder catheter every 8 hours in the first 72 hours.
Ninety-eight men and 34 women were studied. Mean age 48 ± 18 years and a TBSA of 35 ± 22%. The fluid provided by %TBSA in the first 8 hours was less than predicted by Parkland (4.05 ml/kg), although the total contribution in the first 24 hours was similar. The evolution of the intra-abdominal pressure was: admission 9.7 mmHg, 8 hours 11, 16 hours 10.5, 24 hours 12.1, 32 hours 12.0, 40 hours 12.0, 48 hours 11.1, 56 hours 10.3, 64 hours 10.0 and 72 hours 10.0. A total of 44 patients (33.3%) had a determination higher than 12 mmHg, distributed: 15 patients between 12 and 15 mmHg (IAHT I grade), 14 between 16 and 20 mmHg (II), nine between 21 and 25 mmHg (III) and six >25 mmHg (IV). See Figures 1 and 2.
IAH incidence when a slightly restrictive fluid protocol used is less than expected.
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Millan, P. Intraabdominal pressure in critical burn patients. Crit Care 19, P386 (2015). https://doi.org/10.1186/cc14466
- Blood Pressure
- Lactic Acid
- Emergency Medicine