Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY D. Tuggle, S. Skinner, J. Garza, D. Vandijck & S. Blot To cite this article: D. Tuggle, S. Skinner, J. Garza, D. Vandijck & S. Blot (2007) THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY, Acta Clinica Belgica, 62:sup1, 136-140, DOI: 10.1179/acb.2007.62.s1.017 To link to this article: http://dx.doi.org/10.1179/acb.2007.62.s1.017
Published online: 30 May 2014.
Submit your article to this journal
Article views: 5
View related articles
Citing articles: 7 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 Download by: [Orta Dogu Teknik Universitesi]
Date: 08 April 2016, At: 10:39
136
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY
Original article – OA 16
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY D. Tuggle1, S. Skinner1, J. Garza1, D. Vandijck2,3, S. Blot2,3
Downloaded by [Orta Dogu Teknik Universitesi] at 10:39 08 April 2016
Keywords: Abdominal compartment syndrome, burns, resuscitation, escharotomy, paracentesis
ABSTRACT Introduction: Intra-abdominal hypertension (IAH) and subsequent abdominal compartment syndrome (ACS) in burned patients is common. This sequence of events typically occurs in patients with larger burns receiving high volume fluid resuscitation. Methods: A review of the literature was performed. The National Library of Medicine (PUBMED) was queried for “Burn” and “Abdominal Compartment Syndrome”. Twenty-nine articles were retained for study. Results: Abdominal pressure monitoring is appropriate in all patients with burns that require significant volume resuscitation (>30% total burned surface area- TBSA). Prevention of ACS in
––––––––––––––– 1 The University of Oklahoma College of Medicine, Dept. of Surgery, Section of Pediatric Surgery, Oklahoma City, OK, USA; 2 Ghent University, Faculty of Medicine and Health Science, Ghent, Belgium; 3 Ghent University Hospital, Intensive Care Dept., Ghent, Belgium Address for correspondence: Stijn Blot Ghent University Hospital Intensive Care Dept. De Pintelaan 185 9000 Gent Belgium E-mail: [email protected]
Acta Clinica Belgica, 2007; 62-Supplement 1
burns includes limiting fluid resuscitation, burn escharotomy, and percutaneous drainage when abdominal pressures are reaching perilous levels. Treatment includes all of the above and in addition, decompressive laparotomy when needed. However, despite decompressive laparotomy, mortality rates among burn victims with ACS remain unacceptably high. Conclusion: Increasing amounts of volume delivery are associated with an increased risk of IAH. Therefore, intra-abdominal pressure should be monitored in all burn patients requiring massive fluid resuscitation. Escharotomy, paracentesis, and decompressive laparotomy may all be needed to counter the side effects of appropriate fluid resuscitation in the severely burned patient. Nevertheless, the prognosis in burn patients developing ACS is grim.
INTRODUCTION Burned patients represent one of the most challenging management scenarios encountered by surgeons and intensivists. The mortality associated with severe burns continues to be high, but advances in the past few decades have allowed improved survival even in the most extensive burns (1). One particular aspect of initial burn therapy is volume resuscitation. A recent search of PUBMED using the terms “burn fluid resuscitation” revealed 605 references dating back to 1969. There is no doubt that fluid administration in the early management of burns is saving lives, particularly by preventing acute kidney injury (2). As a result, co-morbidities following burn injury shifted from acute kidney injury to pulmonary edema, acute respiratory distress syndrome,
Downloaded by [Orta Dogu Teknik Universitesi] at 10:39 08 April 2016
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY
and secondary abdominal compartment syndrome, all possible side effects of high volume fluid resuscitation. The improved early survival has allowed the manifestation of intra-abdominal hypertension (IAH) as volume resuscitation progresses (3). Besides massive fluid administration, patients with burn injury are at increased risk for developing secondary abdominal compartment syndrome (ACS) because of: (i) decreased compliance of the abdominal wall in case of burns of the trunk, (ii) capillary leakage due to increased permeability, (iii) bowel edema, and (iv) the accumulation of intra-abdominal fluid. It should be emphasized, that not every patient receiving massive fluid resuscitation progresses to ACS which in its turn will be clinically characterized by haemodynamic instability, decreased cardiac output, pulmonary dysfunction, splanchnic ischemia, elevated intracranial pressure, and acute kidney injury (4). The true prevalence of IAH and ACS in patients with burns remains poorly explored. Hobson et al. found IAH to be rare in patients with a burned surface area 40% burned surface area or >25% associated with an inhalation injury), O’Mara et al. demonstrated that resuscitation in accordance with the guidelines as recommended by the Parkland formula (crystalloids) required significantly more fluid volume, compared to with patients resuscitated with plasma (0.26 L/kg vs. 0.21 L/kg; P70% 46%
ACS IAH ACS
100% 70% 20%
100% Not reported 100%
60% 57%
ACS IAH ACS ACS
100% 69% 31% 1%
66% 0% 100% 60%
ACS
≥25 mmHg ≥25 mmHg ≥25 mmHg + organ failure ≥25 mmHg ≥25 mmHg ≥30 mmHg Clinical supported by IAP >20-25 cm H2O
70%
60%
ACS
≥25 mmHg
52%
Not reported
22%
>50%
65%
IAH
>30 cm H2O + organ failure >30 cm H2O
36%
Not reported
48
86%
ACS
17%
Not reported
1 22
60% 50%
ACS IAH
>30 cm H2O + organ failure 34 mmHg >25 mmHg
100% 100%
0% 73%
Design
Type of burn patients
n
Average TBSA Outcome
Greenhalgh, 1994 (24)
P
30
56%
Ivy, 1999 (23) Ivy, 2000 (25)
P P
Burned children with urinary catheter >70% TBSA >20% TBSA
3 10
Corcos, 2001 (19) Latenser, 2002 (17)
P R
>40% TBSA >40% TBSA
3 13
Hobson, 2002 (5)
R
All burn ICU admissions
Tsoutsos, 2003 (15)
P
10
57%
O’Mara, 2005 (11)
P
31
45%
Oda, 2005 (10)
P
Patients >35% TBSA in thoracic / abdominal area >40% TBSA or >25% TBSA + inhalation injury >30% TBSA
36
49%
Oda, 2006 (13)
P
36
Oda, 2006 (3)
P
>40% TBSA without inhalation injury >30% TBSA
Parra, 2006 (18) Kowal-Vern, 2006 (26)
P P
Case report >40% TBSA + inhalation injury
1014 Not reported
Design: P, prospective; R, retrospective TBSA, total burned surface area IAH, intraabdominal hypertension ACS, abdominal compartment syndrome
REFERENCES 1. Brusselaers N, Hoste EA, Monstrey S et al. Outcome and changes over time in survival following severe burns from 1985 to 2004. Intensive Care Med. 2005; 31: 1648-53. 2. Chrysopoulo MT, Jeschke MG, Dziewulski P, Barrow RE, Herndon DN. Acute renal dysfunction in severely burned adults. J Trauma. 1999; 46: 141-4. 3. Oda J, Yamashita K, Inoue T et al. Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns. Burns. 2006; 32: 151-4. 4. Malbrain ML, Cheatham ML, Kirkpatrick A et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006; 32: 1722-32. 5. Hobson KG, Young KM, Ciraulo A, Palmieri TL, Greenhalgh DG. Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma. 2002; 53: 1129-33; discussion 1133-4. 6. Malbrain ML, Chiumello D, Pelosi P et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005; 33: 315-22. 7. Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci. 1968; 150: 874-94.
8. Goodwin CW, Dorethy J, Lam V, Pruitt BA, Jr. Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury. Ann Surg. 1983; 197:520-31. 9. Berger MM, Bernath MA, Chiolero RL. Resuscitation, anaesthesia and analgesia of the burned patient. Curr Opin Anaesthesiol. 2001; 14: 431-5. 10. Oda J, Ueyama M, Yamashita K et al. Effects of escharotomy as abdominal decompression on cardiopulmonary function and visceral perfusion in abdominal compartment syndrome with burn patients. J Trauma. 2005; 59: 369-74. 11. O’Mara MS, Slater H, Goldfarb IW, Caushaj PF. A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma. 2005; 58: 1011-8. 12. Britt RC, Gannon T, Collins JN, Cole FJ, Weireter LJ, Britt LD. Secondary abdominal compartment syndrome: risk factors and outcomes. Am Surg. 2005; 71: 982-5. 13. Oda J, Ueyama M, Yamashita K et al. Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. J Trauma. 2006; 60: 64-71. 14. Ipaktchi K, Arbabi S. Advances in burn critical care. Crit Care Med. 2006; 34: S239-44. 15. Tsoutsos D, Rodopoulou S, Keramidas E, Lagios M, Stamatopoulos K, Ioannovich J. Early escharotomy as a measure to reduce
Acta Clinica Belgica, 2007; 62-Supplement 1
139
140
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY
16.
17.
18.
Downloaded by [Orta Dogu Teknik Universitesi] at 10:39 08 April 2016
19.
20.
intraabdominal hypertension in full-thickness burns of the thoracic and abdominal area. World J Surg. 2003; 27: 1323-8. Jensen AR, Hughes WB, Grewal H. Secondary abdominal compartment syndrome in children with burns and trauma: a potentially lethal complication. J Burn Care. Res. 2006; 27: 242-6. Latenser BA, Kowal-Vern A, Kimball D, Chakrin A, Dujovny N. A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil. 2002; 23: 1905. Parra MW, Al-Khayat H, Smith HG, Cheatham ML. Paracentesis for resuscitation-induced abdominal compartment syndrome: an alternative to decompressive laparotomy in the burn patient. J Trauma. 2006; 60:1119-21. Corcos AC, Sherman HF. Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma. 2001; 51: 10624. De Waele JJ, Hoste EA, Malbrain ML. Decompressive laparotomy for abdominal compartment syndrome--a critical analysis. Crit Care. 2006; 10: R51.
Acta Clinica Belgica, 2007; 62-Supplement 1
21. Ball CG, Kirkpatrick AW, Karmali S et al. Tertiary abdominal compartment syndrome in the burn injured patient. J Trauma. 2006; 61: 1271-3. 22. De Waele JJ, Benoit D, Hoste E, Colardyn F. A role for muscle relaxation in patients with abdominal compartment syndrome? Intensive Care Med. 2003; 29: 332. 23. Ivy ME, Possenti PP, Kepros J et al. Abdominal compartment syndrome in patients with burns. J Burn Care Rehabil. 1999; 20: 351-3. 24. Greenhalgh DG, Warden GD. The importance of intra-abdominal pressure measurements in burned children. J Trauma. 1994; 36: 685-90. 25. Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, D’Aiuto M. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma. 2000; 49: 387-91. 26. Kowal-Vern A, Ortegel J, Bourdon P et al. Elevated cytokine levels in peritoneal fluid from burned patients with intra-abdominal hypertension and abdominal compartment syndrome. Burns. 2006; 32: 563-9.
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY D. Tuggle, S. Skinner, J. Garza, D. Vandijck & S. Blot To cite this article: D. Tuggle, S. Skinner, J. Garza, D. Vandijck & S. Blot (2007) THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY, Acta Clinica Belgica, 62:sup1, 136-140, DOI: 10.1179/acb.2007.62.s1.017 To link to this article: http://dx.doi.org/10.1179/acb.2007.62.s1.017
Published online: 30 May 2014.
Submit your article to this journal
Article views: 5
View related articles
Citing articles: 7 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 Download by: [Orta Dogu Teknik Universitesi]
Date: 08 April 2016, At: 10:39
136
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY
Original article – OA 16
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY D. Tuggle1, S. Skinner1, J. Garza1, D. Vandijck2,3, S. Blot2,3
Downloaded by [Orta Dogu Teknik Universitesi] at 10:39 08 April 2016
Keywords: Abdominal compartment syndrome, burns, resuscitation, escharotomy, paracentesis
ABSTRACT Introduction: Intra-abdominal hypertension (IAH) and subsequent abdominal compartment syndrome (ACS) in burned patients is common. This sequence of events typically occurs in patients with larger burns receiving high volume fluid resuscitation. Methods: A review of the literature was performed. The National Library of Medicine (PUBMED) was queried for “Burn” and “Abdominal Compartment Syndrome”. Twenty-nine articles were retained for study. Results: Abdominal pressure monitoring is appropriate in all patients with burns that require significant volume resuscitation (>30% total burned surface area- TBSA). Prevention of ACS in
––––––––––––––– 1 The University of Oklahoma College of Medicine, Dept. of Surgery, Section of Pediatric Surgery, Oklahoma City, OK, USA; 2 Ghent University, Faculty of Medicine and Health Science, Ghent, Belgium; 3 Ghent University Hospital, Intensive Care Dept., Ghent, Belgium Address for correspondence: Stijn Blot Ghent University Hospital Intensive Care Dept. De Pintelaan 185 9000 Gent Belgium E-mail: [email protected]
Acta Clinica Belgica, 2007; 62-Supplement 1
burns includes limiting fluid resuscitation, burn escharotomy, and percutaneous drainage when abdominal pressures are reaching perilous levels. Treatment includes all of the above and in addition, decompressive laparotomy when needed. However, despite decompressive laparotomy, mortality rates among burn victims with ACS remain unacceptably high. Conclusion: Increasing amounts of volume delivery are associated with an increased risk of IAH. Therefore, intra-abdominal pressure should be monitored in all burn patients requiring massive fluid resuscitation. Escharotomy, paracentesis, and decompressive laparotomy may all be needed to counter the side effects of appropriate fluid resuscitation in the severely burned patient. Nevertheless, the prognosis in burn patients developing ACS is grim.
INTRODUCTION Burned patients represent one of the most challenging management scenarios encountered by surgeons and intensivists. The mortality associated with severe burns continues to be high, but advances in the past few decades have allowed improved survival even in the most extensive burns (1). One particular aspect of initial burn therapy is volume resuscitation. A recent search of PUBMED using the terms “burn fluid resuscitation” revealed 605 references dating back to 1969. There is no doubt that fluid administration in the early management of burns is saving lives, particularly by preventing acute kidney injury (2). As a result, co-morbidities following burn injury shifted from acute kidney injury to pulmonary edema, acute respiratory distress syndrome,
Downloaded by [Orta Dogu Teknik Universitesi] at 10:39 08 April 2016
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY
and secondary abdominal compartment syndrome, all possible side effects of high volume fluid resuscitation. The improved early survival has allowed the manifestation of intra-abdominal hypertension (IAH) as volume resuscitation progresses (3). Besides massive fluid administration, patients with burn injury are at increased risk for developing secondary abdominal compartment syndrome (ACS) because of: (i) decreased compliance of the abdominal wall in case of burns of the trunk, (ii) capillary leakage due to increased permeability, (iii) bowel edema, and (iv) the accumulation of intra-abdominal fluid. It should be emphasized, that not every patient receiving massive fluid resuscitation progresses to ACS which in its turn will be clinically characterized by haemodynamic instability, decreased cardiac output, pulmonary dysfunction, splanchnic ischemia, elevated intracranial pressure, and acute kidney injury (4). The true prevalence of IAH and ACS in patients with burns remains poorly explored. Hobson et al. found IAH to be rare in patients with a burned surface area 40% burned surface area or >25% associated with an inhalation injury), O’Mara et al. demonstrated that resuscitation in accordance with the guidelines as recommended by the Parkland formula (crystalloids) required significantly more fluid volume, compared to with patients resuscitated with plasma (0.26 L/kg vs. 0.21 L/kg; P70% 46%
ACS IAH ACS
100% 70% 20%
100% Not reported 100%
60% 57%
ACS IAH ACS ACS
100% 69% 31% 1%
66% 0% 100% 60%
ACS
≥25 mmHg ≥25 mmHg ≥25 mmHg + organ failure ≥25 mmHg ≥25 mmHg ≥30 mmHg Clinical supported by IAP >20-25 cm H2O
70%
60%
ACS
≥25 mmHg
52%
Not reported
22%
>50%
65%
IAH
>30 cm H2O + organ failure >30 cm H2O
36%
Not reported
48
86%
ACS
17%
Not reported
1 22
60% 50%
ACS IAH
>30 cm H2O + organ failure 34 mmHg >25 mmHg
100% 100%
0% 73%
Design
Type of burn patients
n
Average TBSA Outcome
Greenhalgh, 1994 (24)
P
30
56%
Ivy, 1999 (23) Ivy, 2000 (25)
P P
Burned children with urinary catheter >70% TBSA >20% TBSA
3 10
Corcos, 2001 (19) Latenser, 2002 (17)
P R
>40% TBSA >40% TBSA
3 13
Hobson, 2002 (5)
R
All burn ICU admissions
Tsoutsos, 2003 (15)
P
10
57%
O’Mara, 2005 (11)
P
31
45%
Oda, 2005 (10)
P
Patients >35% TBSA in thoracic / abdominal area >40% TBSA or >25% TBSA + inhalation injury >30% TBSA
36
49%
Oda, 2006 (13)
P
36
Oda, 2006 (3)
P
>40% TBSA without inhalation injury >30% TBSA
Parra, 2006 (18) Kowal-Vern, 2006 (26)
P P
Case report >40% TBSA + inhalation injury
1014 Not reported
Design: P, prospective; R, retrospective TBSA, total burned surface area IAH, intraabdominal hypertension ACS, abdominal compartment syndrome
REFERENCES 1. Brusselaers N, Hoste EA, Monstrey S et al. Outcome and changes over time in survival following severe burns from 1985 to 2004. Intensive Care Med. 2005; 31: 1648-53. 2. Chrysopoulo MT, Jeschke MG, Dziewulski P, Barrow RE, Herndon DN. Acute renal dysfunction in severely burned adults. J Trauma. 1999; 46: 141-4. 3. Oda J, Yamashita K, Inoue T et al. Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns. Burns. 2006; 32: 151-4. 4. Malbrain ML, Cheatham ML, Kirkpatrick A et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006; 32: 1722-32. 5. Hobson KG, Young KM, Ciraulo A, Palmieri TL, Greenhalgh DG. Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma. 2002; 53: 1129-33; discussion 1133-4. 6. Malbrain ML, Chiumello D, Pelosi P et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005; 33: 315-22. 7. Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci. 1968; 150: 874-94.
8. Goodwin CW, Dorethy J, Lam V, Pruitt BA, Jr. Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury. Ann Surg. 1983; 197:520-31. 9. Berger MM, Bernath MA, Chiolero RL. Resuscitation, anaesthesia and analgesia of the burned patient. Curr Opin Anaesthesiol. 2001; 14: 431-5. 10. Oda J, Ueyama M, Yamashita K et al. Effects of escharotomy as abdominal decompression on cardiopulmonary function and visceral perfusion in abdominal compartment syndrome with burn patients. J Trauma. 2005; 59: 369-74. 11. O’Mara MS, Slater H, Goldfarb IW, Caushaj PF. A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma. 2005; 58: 1011-8. 12. Britt RC, Gannon T, Collins JN, Cole FJ, Weireter LJ, Britt LD. Secondary abdominal compartment syndrome: risk factors and outcomes. Am Surg. 2005; 71: 982-5. 13. Oda J, Ueyama M, Yamashita K et al. Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. J Trauma. 2006; 60: 64-71. 14. Ipaktchi K, Arbabi S. Advances in burn critical care. Crit Care Med. 2006; 34: S239-44. 15. Tsoutsos D, Rodopoulou S, Keramidas E, Lagios M, Stamatopoulos K, Ioannovich J. Early escharotomy as a measure to reduce
Acta Clinica Belgica, 2007; 62-Supplement 1
139
140
THE ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH BURN INJURY
16.
17.
18.
Downloaded by [Orta Dogu Teknik Universitesi] at 10:39 08 April 2016
19.
20.
intraabdominal hypertension in full-thickness burns of the thoracic and abdominal area. World J Surg. 2003; 27: 1323-8. Jensen AR, Hughes WB, Grewal H. Secondary abdominal compartment syndrome in children with burns and trauma: a potentially lethal complication. J Burn Care. Res. 2006; 27: 242-6. Latenser BA, Kowal-Vern A, Kimball D, Chakrin A, Dujovny N. A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil. 2002; 23: 1905. Parra MW, Al-Khayat H, Smith HG, Cheatham ML. Paracentesis for resuscitation-induced abdominal compartment syndrome: an alternative to decompressive laparotomy in the burn patient. J Trauma. 2006; 60:1119-21. Corcos AC, Sherman HF. Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma. 2001; 51: 10624. De Waele JJ, Hoste EA, Malbrain ML. Decompressive laparotomy for abdominal compartment syndrome--a critical analysis. Crit Care. 2006; 10: R51.
Acta Clinica Belgica, 2007; 62-Supplement 1
21. Ball CG, Kirkpatrick AW, Karmali S et al. Tertiary abdominal compartment syndrome in the burn injured patient. J Trauma. 2006; 61: 1271-3. 22. De Waele JJ, Benoit D, Hoste E, Colardyn F. A role for muscle relaxation in patients with abdominal compartment syndrome? Intensive Care Med. 2003; 29: 332. 23. Ivy ME, Possenti PP, Kepros J et al. Abdominal compartment syndrome in patients with burns. J Burn Care Rehabil. 1999; 20: 351-3. 24. Greenhalgh DG, Warden GD. The importance of intra-abdominal pressure measurements in burned children. J Trauma. 1994; 36: 685-90. 25. Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, D’Aiuto M. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma. 2000; 49: 387-91. 26. Kowal-Vern A, Ortegel J, Bourdon P et al. Elevated cytokine levels in peritoneal fluid from burned patients with intra-abdominal hypertension and abdominal compartment syndrome. Burns. 2006; 32: 563-9.
