Secondary abdominal compartment syndrome in patients with toxic epidermal necrolysis

Burns, 04/20/2012

Struck MF et al. – An abdominal compartment syndrome (ACS) that requires decompressive laparotomy (DL) worsens the already critical condition of a toxic epidermal necrolysis (TEN) patient considerably. TEN–related impaired intestinal functionality and increasing intestinal edema due to systemic capillary leakage warrant early initiation of intra–abdominal pressure monitoring to identify patients at high risk of ACS.

Methods

  • The authors reviewed the registry of adult patients presenting with TEN in the 8-bed BICU over the course of 11years and identified and analyzed patients treated for ACS and decompressive laparotomy (DL).

Results

  • From a total of 29 patients with bioptic confirmed TEN, 5 underwent DL due to ACS with a mean age of 57years, mean percentage of total body surface area (TBSA) affected of 54±25%, complete epidermolysis of 28±24% TBSA, a mean severity of illness score (SCORTEN) of 3.8±0.8, and a mean intra-abdominal pressure before DL of 33±7mmHg.
  • Mortality was 100% in patients with ACS versus 33% without ACS.

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