ABDOMINAL COMPARTMENT SYNDROME: Presentation of a case series and proposal of UK Guidelines

Introduction: The 2015 and 2016 National Burns Mortality Audits identified abdominal compartment syndrome (ACS) as the most common cause of death in patients with significant burns. The occurrence of ACS appears to be directly related to visceral, abdominal wall and retroperitoneal oedema and ascites induced by over-resuscitation. We identified paediatric and adult patients who developed abdominal catastrophe (defined as ACS or ischaemic bowel), and propose a guideline for Significant Burn Injury Fluid Management in adults to mitigate against ACS.

Methods: A retrospective review of all patients who developed abdominal catastrophe in the Burns unit at Alder Hey Children’s Hospital and the University Hospital of South Manchester from January 2011 to December 2016 was conducted. Case notes were obtained and evaluated to calculate fluid balance with respect to the Parkland’s formula. This was compared with the Ivy score. 

Results: In adults, the average Parkland’s formula rate was 6.14mls/kg/TBSA burns (range 3.7-10). The average resuscitation fluid administered was 0.26L/kg (range 0.15-0.3) over 24h. Of the five adults, one patient died following the diagnosis of small bowel ischaemia and another from an unrelated cause. The remaining three patients are being followed up with outpatient care. The paediatric case received 12,706mls over 24h (1.5times over the Parkland formula). This child died from multiple ischemic insults.

Discussion: In this case series, we demonstrate the development of abdominal compartment syndrome in patients over-resuscitated with fluids in excess of Parkland’s formula and elevated Ivy score (>0.25L/kg over 24h). We posit that patients requiring fluid resuscitation with crystalloids in excess of 4ml/kg/TBSA should be considered for 5% Human Albumin solution boluses in the early post burn period (>8h). We recommend that the measurement of IAP is standardized and propose a guideline for significant burn injury fluid management in adults to mitigate and monitor against the development of ACS.