Patients with impending abdominal compartment syndrome do not respond to early volume loading

Abstract

Background It is recommended that patients with impending abdominal compartment syndrome (ACS) should be volume loaded to insure the adequate preload. We evaluated our prospective resuscitation database to determine how patients who developed ACS differ from non-ACS patients in response to early volume loading. Methods Over 36 months, 152 consecutive high-risk patients were resuscitated by a standard intensive care unit (ICU) protocol that escalates interventions in nonresponders. Interventions, responses, and outcomes are prospectively collected and the characteristics of ACS and non-ACS patients were compared. Results Twenty-three patients (15%) developed ACS and were decompressed 8 ± 1 hours after ICU admission. The ACS and non-ACS patients had similar demographics and injury severity. The severity of pre-ICU shock tended to be greater in the ACS patients. During the first 8 hours of ICU resuscitation, patients who developed ACS received more blood transfusions (11 ± 2 versus 2 ± 0.2 units; P<0.05) and crystalloids (13 ± 2 versus 4 ± 0.3 L; P<0.05). As a result, pulmonary capillary wedge pressure increased more in the ACS patients (20 ± 1.5 versus 15 ± 0.5 mm Hg; P<0.05), but comparatively the cardiac index did not (3.2 ± 0.2 versus 4.2 ± 0.1 L/min/m 2; P<0.05) and the ACS patients developed pathologic elevations of gastric regional CO 2 pressures (70 ± 7 versus 48 ± 1 mm Hg P<0.05). Conclusions Conventional preload directed resuscitation to enhance cardiac function is not effective in patients with impending ACS, and this traditional resuscitation strategy is detrimental in this subgroup of patients.