Intra-abdominal pressure monitoring as a guideline in the nonoperative management of blunt hepatic trauma

Ray Jade Chen, Jen Feng Fang, Miin Fu Chen

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Nonoperative management has been validated as a standard of care for patients with blunt hepatic trauma. We herein study the correlation of intra-abdominal pressure (IAP) and other clinical parameters to predict the failure of nonoperative management, and attempt to use IAP to determine further therapeutic options. Methods: During a 9-month period, 25 hemodynamically stable patients sustaining grades III to V blunt hepatic injuries were prospectively studied. They were admitted to the intensive care unit for clinical reevaluation, and hemodynamic and IAP monitoring. If the patient developed an IAP greater than 25 cm H2O, then an emergent laparotomy or laparoscopy was performed to achieve hemostasis and decompression of intra-abdominal hypertension (IAH). On the basis of an IAP of 25 cm H2O, the correlation between the IAP and an estimated amount of liver-related transfusion, the PaO2/TFIO2 ratio and peritoneal signs were analyzed. Results: Of the 25 patients being studied, 20 (80%) had an IAP below 25 cm H2O, 1 of whom was found to have a pelvic abscess from an amputated segment of liver. On the other hand, five other patients with an IAP greater than 25 cm H2O received decompression and laparoscopic examinations, and one needed an open hepatorrhaphy. In general, though, 19 patients (76%) were successfully treated without operation. All recovered well after different therapeutic regimens; however, two developed liver abscesses, for a morbidity rate of 8% (2 of 25). This analysis revealed a strong association between the IAP value and the presence of peritoneal signs (Phi coefficient = 0.890, p <0.001), but not in the estimated amount of liver-related transfusion and PaO2/FIO2 ratio. Conclusion: This preliminary investigation suggests that IAH or abdominal compartment syndrome can develop while patients receive nonoperative management for grade III to V blunt hepatic injuries. There were no parameters that precisely reflected ongoing hepatic hemorrhage or predicted hemodynamic instability. Although the amount of hepatic hemorrhage was not accurately measured by the IAP, it could be reflected by an increased IAP. During nonoperative management, IAP monitoring may be a simple and objective guideline to suggest further intervention for patients with blunt hepatic trauma. Laparoscopic hepatic evaluation and abdominal decompression may be helpful in this situation.

Original languageEnglish
Pages (from-to)44-50
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume51
Issue number1
Publication statusPublished - Jul 2001
Externally publishedYes

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Guidelines
Pressure
Liver
Wounds and Injuries
Intra-Abdominal Hypertension
Nonpenetrating Wounds
Decompression
Hemodynamics
Lower Body Negative Pressure
Hemorrhage
Liver Abscess
Standard of Care
Hemostasis
Laparoscopy
Laparotomy
Abscess
Intensive Care Units
Morbidity
Therapeutics

Keywords

  • Abdominal compartment syndrome (ACS)
  • Blunt hepatic trauma
  • Intra-abdominal hypertension (IAH)
  • Intra-abdominal pressure (IAP)
  • Liver-related transfusion
  • Nonoperative management

ASJC Scopus subject areas

  • Surgery

Cite this

Intra-abdominal pressure monitoring as a guideline in the nonoperative management of blunt hepatic trauma. / Chen, Ray Jade; Fang, Jen Feng; Chen, Miin Fu.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 51, No. 1, 07.2001, p. 44-50.

Research output: Contribution to journalArticle

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abstract = "Background: Nonoperative management has been validated as a standard of care for patients with blunt hepatic trauma. We herein study the correlation of intra-abdominal pressure (IAP) and other clinical parameters to predict the failure of nonoperative management, and attempt to use IAP to determine further therapeutic options. Methods: During a 9-month period, 25 hemodynamically stable patients sustaining grades III to V blunt hepatic injuries were prospectively studied. They were admitted to the intensive care unit for clinical reevaluation, and hemodynamic and IAP monitoring. If the patient developed an IAP greater than 25 cm H2O, then an emergent laparotomy or laparoscopy was performed to achieve hemostasis and decompression of intra-abdominal hypertension (IAH). On the basis of an IAP of 25 cm H2O, the correlation between the IAP and an estimated amount of liver-related transfusion, the PaO2/TFIO2 ratio and peritoneal signs were analyzed. Results: Of the 25 patients being studied, 20 (80{\%}) had an IAP below 25 cm H2O, 1 of whom was found to have a pelvic abscess from an amputated segment of liver. On the other hand, five other patients with an IAP greater than 25 cm H2O received decompression and laparoscopic examinations, and one needed an open hepatorrhaphy. In general, though, 19 patients (76{\%}) were successfully treated without operation. All recovered well after different therapeutic regimens; however, two developed liver abscesses, for a morbidity rate of 8{\%} (2 of 25). This analysis revealed a strong association between the IAP value and the presence of peritoneal signs (Phi coefficient = 0.890, p <0.001), but not in the estimated amount of liver-related transfusion and PaO2/FIO2 ratio. Conclusion: This preliminary investigation suggests that IAH or abdominal compartment syndrome can develop while patients receive nonoperative management for grade III to V blunt hepatic injuries. There were no parameters that precisely reflected ongoing hepatic hemorrhage or predicted hemodynamic instability. Although the amount of hepatic hemorrhage was not accurately measured by the IAP, it could be reflected by an increased IAP. During nonoperative management, IAP monitoring may be a simple and objective guideline to suggest further intervention for patients with blunt hepatic trauma. Laparoscopic hepatic evaluation and abdominal decompression may be helpful in this situation.",
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N2 - Background: Nonoperative management has been validated as a standard of care for patients with blunt hepatic trauma. We herein study the correlation of intra-abdominal pressure (IAP) and other clinical parameters to predict the failure of nonoperative management, and attempt to use IAP to determine further therapeutic options. Methods: During a 9-month period, 25 hemodynamically stable patients sustaining grades III to V blunt hepatic injuries were prospectively studied. They were admitted to the intensive care unit for clinical reevaluation, and hemodynamic and IAP monitoring. If the patient developed an IAP greater than 25 cm H2O, then an emergent laparotomy or laparoscopy was performed to achieve hemostasis and decompression of intra-abdominal hypertension (IAH). On the basis of an IAP of 25 cm H2O, the correlation between the IAP and an estimated amount of liver-related transfusion, the PaO2/TFIO2 ratio and peritoneal signs were analyzed. Results: Of the 25 patients being studied, 20 (80%) had an IAP below 25 cm H2O, 1 of whom was found to have a pelvic abscess from an amputated segment of liver. On the other hand, five other patients with an IAP greater than 25 cm H2O received decompression and laparoscopic examinations, and one needed an open hepatorrhaphy. In general, though, 19 patients (76%) were successfully treated without operation. All recovered well after different therapeutic regimens; however, two developed liver abscesses, for a morbidity rate of 8% (2 of 25). This analysis revealed a strong association between the IAP value and the presence of peritoneal signs (Phi coefficient = 0.890, p <0.001), but not in the estimated amount of liver-related transfusion and PaO2/FIO2 ratio. Conclusion: This preliminary investigation suggests that IAH or abdominal compartment syndrome can develop while patients receive nonoperative management for grade III to V blunt hepatic injuries. There were no parameters that precisely reflected ongoing hepatic hemorrhage or predicted hemodynamic instability. Although the amount of hepatic hemorrhage was not accurately measured by the IAP, it could be reflected by an increased IAP. During nonoperative management, IAP monitoring may be a simple and objective guideline to suggest further intervention for patients with blunt hepatic trauma. Laparoscopic hepatic evaluation and abdominal decompression may be helpful in this situation.

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