Abdominal Compartment Syndrome

Massive fluid replacement (> 250 mL/kg within 24 hours) is a risk factor for abdominal compartment syndrome (ACS), a clinical diagnosis which includes increased bladder pressure, increased airway pressure, oliguria, and hypotension.24,25 Bladder pressure > 20 mmHg warrants consideration of therapeutic paracentesis which may provide partial relief. A bladder pressure > 30 mmHg, when measured accurately, is a serious finding that mandates immediate assessment and treatment.

Decompressive laparotomy, when performed for ACS in patients with massive burns, almost always indicates a nonsurvivable situation. The decision to pursue decompressive laparotomy must consider this fact.24

PLEASE CALL THE BURN CENTER PRIOR TO PROCEDURE! Avoiding over resuscitation is key to avoiding ACS.

If the patient requires a decompressive laparotomy, perform a standard midline incision followed by temporary abdominal closure. If the abdominal wall skin is burned, adhesive drapes for negative pressure wound dressings will not adhere to the skin edges. Use of Stomahesive paste or another barrier is recommended.