Secondary Abdominal Compartment Syndrome Associated with Massive Fluid Resuscitation in Extensive Burn Patients : Report of Two Cases and a Revision of the Institutional Fluid Resuscitation Protocol

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Secondary abdominal compartment syndrome (s-ACS) is a serious complication with high mortality in patients with extensive burns requiring extensive fluid therapy to maintain the hemodynamic state. This report presents 2 cases of extensive burn patients complicated with s-ACS requiring surgical decompression. Fluid resuscitation was administered according to Parkland formula, using urinary output as the primary parameter to assess the volume status and tissue perfusion. The first case had a scald burn with an 80% total burn surface area (TBSA) requiring 28 L over 17 h. The second case was scald burn with a 77% TBSA requiring 31 L over 20 h. These cases required a revision of the institutional fluid resuscitation protocol for burn patients during the initial 24 h after the injury. The revised protocol divided burn patients into ≥ 60% TBSA or < 60%, according to the risk for the development of s-ACS following fluid resuscitation using crystalloids. In addition, the protocol provide mandatory sequential monitoring of intra-abdominal pressure (IAP) by measuring intra-bladder pressure (IBP) and aggressive intervention from the early post-burn period, when the patients required more than 250cc/kg during the first 24 h post-burn period. The revised protocol may reduce the development of s-ACS.

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