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

Background: Nonoperative management has been validated as a standard of car e for patients with blunt hepatic trauma. We herein study the correlation o f intra-abdominal pressure (IAP) and other clinical parameters to predict t he failure of nonoperative management, and attempt to use IAP to determine further therapeutic options. Methods: During a 9-month period, 25 hemodynamically stable patients sustai ning grades III to V blunt hepatic injuries were prospectively studied, The y were admitted to the intensive care unit for clinical reevaluation and he modynamic and IAP monitoring, If the patient developed an IAP greater than 25 cm H2O, then an emergent laparotomy or laparoscopy was performed to achi eve 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 es timated amount of liver- related transfusion, the Pao(2/)Fro(2), 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 nee ded an open hepatorrhaphy, In general, though, 19 patients (76%) were succe ssfully treated without operation. All recovered well after different thera peutic regimens; however; two developed liver abscesses, for a morbidity ra te 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 Pao(2)/Fro(2) ratio. Conclusion: This preliminary investigation suggests that LAB or abdominal c ompartment syndrome can develop while patients receive nonoperative manage; ment for grade III to V blunt hepatic injuries, There were no parameters t hat 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 nono perative management, IAP monitoring may be a simple and objective guideline to suggest further intervention for patients with blunt hepatic trauma, La paroscopic hepatic evaluation and abdominal decompression may be helpful in this situation.