Secondary abdominal compartment syndrome in patients with toxic epidermal necrolysis

Abstract Introduction Secondary abdominal compartment syndrome (ACS) is a severe complication in patients admitted to burn intensive care units (BICUs). Unlike patients with thermal burns, patients with toxic epidermal necrolysis (TEN) present with a different pathophysiology and usually require les...

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Bibliographic Details
Published in:Burns 2012-06, Vol.38 (4), p.562-567
Main Authors: Struck, Manuel Florian, Illert, Till, Schmidt, Thomas, Reichelt, Beate, Steen, Michael
Format: Article
Language:English
Subjects:
Abdomen
Abdominal compartment syndrome
Adult
Adverse drug reactions
Aged, 80 and over
Biological and medical sciences
Bullous diseases of the skin
Burns
Burns - complications
Critical Care
Decompression, Surgical
Decompressive laparotomy
Dermatology
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Intra-Abdominal Hypertension - etiology
Intra-Abdominal Hypertension - physiopathology
Intra-Abdominal Hypertension - surgery
Laparotomy
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Pressure
Risk Factors
Severity of Illness Index
Stevens-Johnson Syndrome - complications
Stevens-Johnson Syndrome - mortality
Toxic epidermal necrolysis
Traumas. Diseases due to physical agents
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Summary:Abstract Introduction Secondary abdominal compartment syndrome (ACS) is a severe complication in patients admitted to burn intensive care units (BICUs). Unlike patients with thermal burns, patients with toxic epidermal necrolysis (TEN) present with a different pathophysiology and usually require less fluid. Patients and methods We reviewed our registry of adult patients presenting with TEN in our 8-bed BICU over the course of 11 years 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 57 years, 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 ± 7 mmHg. Mortality was 100% in patients with ACS versus 33% without ACS. Conclusion An ACS that requires DL worsens the already critical condition of a 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.
ISSN:0305-4179
1879-1409
DOI:10.1016/j.burns.2011.10.004