Abdominal Complications after Severe Burns

Katharine W. Markell, Evan M. Renz, Christopher E. White, Michael E. Albrecht, Lorne H. Blackbourne, Myung (Michelle) S Park, David A. Barillo, Kevin K. Chung, Rosemary A. Kozar, Joseph P. Minei, Stephen M. Cohn, David N. Herndon, Leopoldo C. Cancio, John B. Holcomb, Steven E. Wolf

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background: Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sought to define incidence, outcomes, and associated factors, such as excessive resuscitation volume and treatment issues. Study Design: We examined all severely burned military and civilian patients with abdominal pathology between March 2003 and February 2008. Data included age, gender, total body surface area burn, inhalation injury, Injury Severity Score, disposition, resuscitation volume, time from injury to diagnosis, use of recombinant factor VIIa, vasopressors, and early tube feedings. We assembled a Delphi panel of surgeons experienced in abdominal catastrophes to review these data. Results: Among 1,825 patients admitted to the US Army Institute of Surgical Research Burn Center, 120 (6.6%) were diagnosed with abdominal pathology (burn size 48% ± 19%), of which 51 (2.8%) had abdominal catastrophe. The majority of these occurred in the first days after injury with associated abdominal compartment syndrome (32 of 51) and increased linearly to burn size. We noted another group of patients who presented primarily with ischemic bowel later in the course, with the same clinical presentation. Resuscitation volume was 6.02 mL/kg/percent total body surface area burned. Vasopressors were used in 71% of patients and tube feedings in 57% before diagnosis. Conclusions: Abdominal catastrophe without abdominal trauma occurs in 2.8% of our population. Associated mortality was 78% without obvious cause. Delphi panel experts recommended more aggressive monitoring of abdominal compartment pressures and earlier operative management to improve outcomes.

Original languageEnglish (US)
Pages (from-to)940-947
Number of pages8
JournalJournal of the American College of Surgeons
Volume208
Issue number5
DOIs
StatePublished - May 2009
Externally publishedYes

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Burns
Resuscitation
Burn Units
Body Surface Area
Wounds and Injuries
Enteral Nutrition
Inhalation Burns
Intra-Abdominal Hypertension
Pathology
Abdominal Injuries
Injury Severity Score
Incidence
Pressure
Mortality
Population
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Markell, K. W., Renz, E. M., White, C. E., Albrecht, M. E., Blackbourne, L. H., Park, M. M. S., ... Wolf, S. E. (2009). Abdominal Complications after Severe Burns. Journal of the American College of Surgeons, 208(5), 940-947. https://doi.org/10.1016/j.jamcollsurg.2008.12.023

Abdominal Complications after Severe Burns. / Markell, Katharine W.; Renz, Evan M.; White, Christopher E.; Albrecht, Michael E.; Blackbourne, Lorne H.; Park, Myung (Michelle) S; Barillo, David A.; Chung, Kevin K.; Kozar, Rosemary A.; Minei, Joseph P.; Cohn, Stephen M.; Herndon, David N.; Cancio, Leopoldo C.; Holcomb, John B.; Wolf, Steven E.

In: Journal of the American College of Surgeons, Vol. 208, No. 5, 05.2009, p. 940-947.

Research output: Contribution to journalArticle

Markell, KW, Renz, EM, White, CE, Albrecht, ME, Blackbourne, LH, Park, MMS, Barillo, DA, Chung, KK, Kozar, RA, Minei, JP, Cohn, SM, Herndon, DN, Cancio, LC, Holcomb, JB & Wolf, SE 2009, 'Abdominal Complications after Severe Burns', Journal of the American College of Surgeons, vol. 208, no. 5, pp. 940-947. https://doi.org/10.1016/j.jamcollsurg.2008.12.023
Markell, Katharine W. ; Renz, Evan M. ; White, Christopher E. ; Albrecht, Michael E. ; Blackbourne, Lorne H. ; Park, Myung (Michelle) S ; Barillo, David A. ; Chung, Kevin K. ; Kozar, Rosemary A. ; Minei, Joseph P. ; Cohn, Stephen M. ; Herndon, David N. ; Cancio, Leopoldo C. ; Holcomb, John B. ; Wolf, Steven E. / Abdominal Complications after Severe Burns. In: Journal of the American College of Surgeons. 2009 ; Vol. 208, No. 5. pp. 940-947.
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abstract = "Background: Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sought to define incidence, outcomes, and associated factors, such as excessive resuscitation volume and treatment issues. Study Design: We examined all severely burned military and civilian patients with abdominal pathology between March 2003 and February 2008. Data included age, gender, total body surface area burn, inhalation injury, Injury Severity Score, disposition, resuscitation volume, time from injury to diagnosis, use of recombinant factor VIIa, vasopressors, and early tube feedings. We assembled a Delphi panel of surgeons experienced in abdominal catastrophes to review these data. Results: Among 1,825 patients admitted to the US Army Institute of Surgical Research Burn Center, 120 (6.6{\%}) were diagnosed with abdominal pathology (burn size 48{\%} ± 19{\%}), of which 51 (2.8{\%}) had abdominal catastrophe. The majority of these occurred in the first days after injury with associated abdominal compartment syndrome (32 of 51) and increased linearly to burn size. We noted another group of patients who presented primarily with ischemic bowel later in the course, with the same clinical presentation. Resuscitation volume was 6.02 mL/kg/percent total body surface area burned. Vasopressors were used in 71{\%} of patients and tube feedings in 57{\%} before diagnosis. Conclusions: Abdominal catastrophe without abdominal trauma occurs in 2.8{\%} of our population. Associated mortality was 78{\%} without obvious cause. Delphi panel experts recommended more aggressive monitoring of abdominal compartment pressures and earlier operative management to improve outcomes.",
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AU - Markell, Katharine W.

AU - Renz, Evan M.

AU - White, Christopher E.

AU - Albrecht, Michael E.

AU - Blackbourne, Lorne H.

AU - Park, Myung (Michelle) S

AU - Barillo, David A.

AU - Chung, Kevin K.

AU - Kozar, Rosemary A.

AU - Minei, Joseph P.

AU - Cohn, Stephen M.

AU - Herndon, David N.

AU - Cancio, Leopoldo C.

AU - Holcomb, John B.

AU - Wolf, Steven E.

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N2 - Background: Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sought to define incidence, outcomes, and associated factors, such as excessive resuscitation volume and treatment issues. Study Design: We examined all severely burned military and civilian patients with abdominal pathology between March 2003 and February 2008. Data included age, gender, total body surface area burn, inhalation injury, Injury Severity Score, disposition, resuscitation volume, time from injury to diagnosis, use of recombinant factor VIIa, vasopressors, and early tube feedings. We assembled a Delphi panel of surgeons experienced in abdominal catastrophes to review these data. Results: Among 1,825 patients admitted to the US Army Institute of Surgical Research Burn Center, 120 (6.6%) were diagnosed with abdominal pathology (burn size 48% ± 19%), of which 51 (2.8%) had abdominal catastrophe. The majority of these occurred in the first days after injury with associated abdominal compartment syndrome (32 of 51) and increased linearly to burn size. We noted another group of patients who presented primarily with ischemic bowel later in the course, with the same clinical presentation. Resuscitation volume was 6.02 mL/kg/percent total body surface area burned. Vasopressors were used in 71% of patients and tube feedings in 57% before diagnosis. Conclusions: Abdominal catastrophe without abdominal trauma occurs in 2.8% of our population. Associated mortality was 78% without obvious cause. Delphi panel experts recommended more aggressive monitoring of abdominal compartment pressures and earlier operative management to improve outcomes.

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