Both Primary and Secondary Abdominal Compartment Syndrome can be Predicted Early and are Harbingers of Multiple Organ Failure

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Abstract
Background Primary (1°) abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary (2°) ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of 1° and 2° ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion. Methods Major torso trauma patients underwent standardized resuscitation and had prospective data collected including occurrence of ACS, demographics, ISS, urinary bladder pressure, gastric tonometry (GAPCO2 = gastric regional CO2 minus end tidal CO2), laboratory, respiratory, and hemodynamic data. With 1° and 2° ACS as endpoints, variables were tested by uni- and multivariate logistic analysis (MLA). Results From 188 study patients during the 44-month period, 26 (14%) developed ACS—11 (6%) were 1° ACS and 15 (8%) 2° ACS. 1° and 2° ACS had similar demographics, shock, and injury severity. Significant univariate differences included: time to decompression from ICU admit (600 ± 112 vs. 360 ± 48 min), Emergency Department (ED) crystalloid (4 ± 1 vs. 7 ± 1 L), preICU crystalloid (8 ± 1 vs. 12 ± 1L), ED blood administration (2 ± 1 vs. 6 ± 1 U), GAPCO2 (24 ± 3 vs. 36 ± 3 mmHg), requiring pelvic embolization (9 vs. 47%), and emergency operation (82% vs. 40%). Early predictors identified by MLA of 1° ACS included hemoglobin concentration, GAPCO2, temperature, and base deficit; and for 2° ACS they included crystalloid, urinary output, and GAPCO2. The areas under the receiver-operator characteristic curves calculated upon ICU admission are 1° = 0.977 and 2° = 0.983. 1° and 2° ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (1° = 13 ± 3 vs. 2° = 14 ± 3 vs. nonACS = 8 ± 2), multiple organ failure (55% vs. 53% vs. 12%), and mortality (64% vs. 53% vs. 17%). Conclusion 1° and 2° ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2° ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.