THE IMPORTANCE OF INTRAABDOMINAL PRESSURE MEASUREMENTS IN BURNED CHILDREN

Four burned children suffering complications from elevated intra-abdominal pressures prompted initiation of a prospective study to determine the value of intra-abdominal pressure measurements in 30 children with large bums. Intra-abdominal pressures were measured every 4 hours during burn shock or sepsis, or daily during periods of stability. Patients were arbitrarily divided into those having one or more measurements greater-than-or-equal-to 30 mm Hg or all values < 30 mm Hg. Patients in the greater-than-or-equal-to 30 mm Hg group had significantly larger bums, higher mortality, and increased instances of sepsis. Five patients had elevated intra-abdominal pressures during burn shock, with two requiring abdominal escharotomies. Seven were at >30 mm Hg during sepsis, with three requiring paralysis, and one each requiring placement of a peritoneal catheter or laparotomy. Significant intra-abdominal pressure elevations may occur in patients with extensive burns and are associated with a poorer prognosis. Elevation of intra-abdominal pressure should be considered in severely burned patients with oliguria, hypoventilation, or hypotension.