Massive fluid replacement (> 250 mL/kg within 24 hours) is a risk factor for abdominal compartment syndrome, a clinical diagnosis which includes increased bladder pressure, increased airway pressures, oliguria, and hypotension.7,8 Bladder pressure > 20 mm Hg in the setting of this syndrome warrants early consideration of therapeutic paracentesis which may provide partial relief of elevated intra-abdominal pressure related to sequestration of resuscitation fluid in burn patients.

The decision to pursue decompressive laparotomy must factor in the significant risk of morbidity and mortality from the procedure in patients with extensive burns or burns to the abdominal wall.7 If the patient requires a decompressive laparotomy, perform a standard celiotomy followed by a temporary abdominal closure. If the abdominal wall skin is burned, adhesive drapes for negative pressure wound dressings (NPWD) will not adhere to the skin edges. Use of a Bogotá bag or similar sterile plastic material sewn to the skin edges is preferred.