Linea Alba Fasciotomy: A Novel Alternative in Trauma Patients with Secondary Abdominal Compartment Syndrome
| Autor: | Calvin Eriksen, Norman E. McSwain, Kelly V. Rennie, Manu L N G Malbrain, Juan Duchesne, Paul E. Hastings, Meghan P. Howell, Georgia M. Wahl |
|---|---|
| Přispěvatelé: | Supporting clinical sciences, Intensive Care |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Resuscitation medicine.medical_specialty Abdominal compartment syndrome Decompression medicine.medical_treatment Pilot Projects Wounds Nonpenetrating Compartment Syndromes Fasciotomy Abdominal decompression Laparotomy medicine Humans Medicine(all) Multiple Trauma business.industry Stroke Volume General Medicine Middle Aged Decompression Surgical medicine.disease Polytrauma Surgery Treatment Outcome Pancreatitis Ventricular Function Right young adult Injury Severity Score Female business fasciotomy |
| Zdroj: | The American Surgeon. 76:312-316 |
| ISSN: | 1555-9823 0003-1348 |
| Popis: | Polytrauma patients needing aggressive resuscitation can develop intra-abdominal hypertension (IAH) with subsequent secondary abdominal compartment syndrome (SACS). After patients fail medical therapy, decompressive laparotomy is the surgical last resort. In patients with severe pancreatitis SACS, the use of linea alba fasciotomy (LAF) is an effective intervention to lower IAH without the morbidity of laparotomy. A pilot study of LAF was designed to evaluate its benefit in patients with SACS polytrauma. We conducted an observational study of blunt injury polytrauma patients undergoing LAF. Variables measured before and after LAF included intra-abdominal pressure (IAP, mmHg), abdominal perfusion pressure (APP, mmHg), right ventricular end diastolic volume index (RVEDVI, mL/m2), and ejection fraction. Of the five trauma patients with SACS, the mean age was 36 ± 17, four (80%) male with an Injury Severity Score of 27 ± 9. Pre- and post-LAF, IAP was 20.6 ± 4.7 and 10.6 ± 2.7 ( P < 0.0001), APP 55.2 ± 5.5 and 77.6 ± 7.1 ( P < 0.0001), RVEDVI 86.4 ± 9.3 and 123.6 ± 11.9 ( P < 0.0001), and EF 27.6 ± 4.2 and 40.8 ± 5 ( P < 0.0001), respectively. One patient needed full decompression for bile ascites from unrecognized liver injury. Linea alba fasciotomy, as a first-line intervention before committing to full abdominal decompression in patients with SACS trauma, improved physiological variables without mortality Consideration for LAF as a bridge before full abdominal decompression needs further evaluation in patients with polytrauma SACS. |
| Databáze: | OpenAIRE |
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