Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure

Background: Primary (1degrees) abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary (2degrees) ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of 1degrees and 2degrees 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 (GAP(CO2) = gastric regional CO2 minus end tidal CO2), laboratory, respiratory, and hemodynamic data. With 1degrees and 2degrees 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 1degrees ACS and 15 (8%) 2degrees ACS. 1degrees and 2degrees 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), GAP(CO2) (24 +/- 3 vs. 36 +/- 3 mmHg), requiring pelvic embolization (9 vs. 47%), and emergency operation (82% vs. 40%). Early predictors identified by MLA of 1degrees ACS included hemoglobin concentration, GAP(CO2), temperature, and base deficit; and for 2degrees ACS they included crystalloid, urinary output, and GAP(CO2). The areas under the receiver-operator characteristic curves calculated upon ICU admission are 1degrees = 0.977 and 2degrees = 0.983. 1degrees and 2degrees ACS patients had similar poor outcomes compared with nonACS patients including ventilator days (1degrees = 13 +/- 3 vs. 2degrees = 14 3 vs. nonACS = 8 +/- 2), multiple organ failure (55% vs. 53% vs. 12%), and mortality (64% vs. 53% vs. 17%). Conclusion: 1degrees and 2degrees ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2degrees ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.