THE IMPORTANCE OF INTRAABDOMINAL PRESSURE MEASUREMENTS IN BURNED CHILDREN

Four burned children suffering complications from elevated intra-abdom inal pressures prompted initiation of a prospective study to determine the value of intra-abdominal pressure measurements in 30 children wit h large bums. Intra-abdominal pressures were measured every 4 hours du ring burn shock or sepsis, or daily during periods of stability. Patie nts were arbitrarily divided into those having one or more measurement s 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 larg er bums, higher mortality, and increased instances of sepsis. Five pat ients had elevated intra-abdominal pressures during burn shock, with t wo requiring abdominal escharotomies. Seven were at >30 mm Hg during s epsis, with three requiring paralysis, and one each requiring placemen t 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 pres sure should be considered in severely burned patients with oliguria, h ypoventilation, or hypotension.