Identifying patients at risk for high-grade intra-abdominal hypertension following trauma laparotomy

Background: Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who developed high-grade intra-abdominal hypertension (IAH) (i.e., grade III or IV; intra-abdominal pressure, IAP >20. mmHg) following an injury-related laparotomy versus those who did not (i.e., IAP ≤20. mmHg).

Methods: A retrospective analysis of consecutive trauma patients admitted to a level 1 trauma centre in Australia between January 1, 1995 and January 31, 2010 was performed. A comparison was made between characteristics of patients who developed high-grade IAH following trauma laparotomy versus those who did not.

Results: A total of 567 patients (median age 31 years) were included in this study. Of these patients 10.2% (58/567) developed high-grade IAH of which 51.7% (30/58) developed ACS. Patients with high-grade IAH were older (p <. 0.001), had a higher Injury Severity Score (p <. 0.001), larger base deficit (p <. 0.001) and lower temperature at admission (p = 0.011). In the first 24. h of admission, patients with high-grade IAH received larger volumes of crystalloids (p <. 0.001), larger volumes of colloids (p <. 0.001) and more units of packed red blood cells (p <. 0.001). Following surgery prolonged prothrombin (p <. 0.001) and partial thromboplastin times (p <. 0.001) were seen. The patients with high-grade IAH suffered higher mortality rates (25.9% (15/58) vs. 12.2% (62/509); p = 0.012).

Conclusion: Of all patients who underwent a trauma laparotomy, 10.2% developed high-grade IAH, which increases the risk of mortality. Patients with acidosis, coagulopathy, and hypothermia were especially at risk. In these patients, the abdomen should be left open until adequate resuscitation has been achieved, allowing for definitive surgery. Level of evidence: This is a level III retrospective study.