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Minimally Invasive Management of the Abdominal Compartment Syndrome: Initial Experience at a Level I Trauma Center
Forrest Fernandez, Vicente Cortes, Robert Brautigam, George Perdrizet
University of Connecticut/Hartford Hospital, Hartofrd, CT
Objective Determine if patients who develop abdominal compartment syndrome (ACS), while being managed non-operatively for blunt thoraco-abdominall trauma, could be treated with percutaneous ultrasound-guided abdominal paracentesis (PUP) and avoid decompressive ceilotomy. Previous animal work demonstrated effective reduction in ACS by small volume paracentesis, prompting our pilot clinical study.
Design/Setting/Patients A retrospective chart review of seven sequential adult patients admitted to a Level I Trauma Center at a university affiliated hospital for nonoperative management of severe blunt thoraco-abdominal trauma with IRB approval.
Intervention All patients had abdominal ultrasound-guided location of intra-peritoneal fluid then had percutaneous aspiration suing a 14-16Ga catheter.
Outcome Reduction in intra-abdominal compartment pressure and resolution of the ACS. Complications associated with PUP.
Results: Seven sequential cases of ACS treated by PUP over a 2 year period. All patients had resolution of clinical manifestations of ACS for which decompression was deemed necessary following PUP procedure (7/7). One patient expired secondary to a malignant cardiac arrhythmia and two died of traumatic brain injuries. Survival for the series was 57% (4/7).
Conclusion: PUP represents a safe, rapid, and efficacious alternative to DC in selected patients with ACS secondary to blunt thoraco-abdominal trauma.
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