16.09 Comparison of Outcomes Among Patients With Abdominal Compartment Syndrome in Medical or Surgical ICU

Posted on January 25, 2017

J. Nguyen1, M. Noory1, L. Capano-Wehrle1, J. Gaughan1, J. Hazelton1  1Cooper University Hospital,Trauma And Surgical Critical Care,Camden, NJ, USA

Introduction:
The causes of abdominal compartment syndrome (ACS) are varied but can result from a range of both medical and surgical pathologies. Early recognition of ACS and prompt surgical treatment in the form of decompressive laparotomy has been shown to improve mortality. We hypothesize that earlier recognition of ACS, and therefore, earlier involvement by the surgical team would improve mortality.

Methods:
A retrospective review of patients ≥18y (7/2010 – 7/2015) who developed ACS and underwent decompressive laparotomy was performed. Patients cared for in non-ICU settings or who developed ACS from abdominal hemorrhage were excluded. Patients were divided into SICU and MICU arms based on their physical location at time of diagnosis. Demographics and clinical data points including hemodynamics, lab values, time to intervention, and outcomes were collected. A timeline was established for each patient from time of suspicion of ACS, time to surgical consult, and time to surgical intervention.

Results:
A total of 20 patients were included(MICU=12; SICU=8). There was no difference in age, sex, and APACHE-2 score at time of suspicion of ACS between the two groups (all p>.05). Median time from admission to suspicion of ACS for MICU patients was 60 hr vs 13 hr for SICU patients (p=.013). Time from suspicion to surgical consult for MICU patients was 60 min vs 0 min for SICU patients (p=.003), however time from surgical consult to surgical intervention was not different (MICU 53 min vs SICU 60 min; p=.396). Outcomes revealed that death occurred in the MICU group at 83% vs 12.5% in the SICU (p = .005).

Conclusion:
Patients in the SICU who developed ACS were more quickly diagnosed than those in the MICU. Furthermore, these patients had a shorter time from suspicion of ACS to surgical consultation and eventual surgical intervention, resulting in improved survival. A multidisciplinary approach, including early surgical consultation, for patients in whom there is a suspicion of ACS could improve mortality.