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Therapie thermischer Verletzungen Ort: Raum 16a, 1. OG | |
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Abdominal Compartment Syndrome in Severely Burned Patients: A Systematic Review and Meta-Analysis 1: Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany; 2: University of Heidelberg, Medical Faculty, Heidelberg, Germany Background Abdominal compartment syndrome (ACS) is a rare but devastating complication in severely burned patients, associated with profound organ dysfunction and high mortality. Since the only burn-specific systematic review published in 2014, additional observational data have emerged, yet the epidemiology, definitions, management strategies, and outcomes of ACS in burn patients remain incompletely characterized. We performed an updated systematic review to synthesize contemporary evidence on ACS in severe burn injury. Methods A systematic literature search of PubMed/MEDLINE, Embase, and Web of Science was conducted according to PRISMA guidelines. Studies reporting intra-abdominal hypertension (IAH) or ACS in burn patients were eligible. Observational cohort and case–control studies were synthesized quantitatively where appropriate; case reports and case series were summarized narratively. Random-effects meta-analyses were performed for mortality and selected baseline characteristics using Hartung–Knapp adjustment. Study selection and data synthesis followed a predefined protocol. Results The search identified 867 records; 19 studies published between 1999 and 2022 met inclusion criteria. A total of 203 burn patients with ACS treated by decompressive laparotomy were analyzed. Mean burn size was 59.6% total body surface area, and inhalation injury was present in 33.5% of patients. Definitions of ACS and intra-abdominal pressure (IAP) thresholds were heterogeneous; reported pre-intervention IAP ranged from 28 to 57 mmHg. ACS most frequently developed within the first 24 hours after injury and was commonly associated with aggressive fluid resuscitation and reduced abdominal wall compliance. Overall mortality was 72.7%. Meta-analysis of observational studies yielded a pooled mortality proportion of 0.72 (95% CI 0.55–0.85) with substantial heterogeneity. Conclusion ACS in severely burned patients remains associated with extremely high mortality. The available evidence is limited by heterogeneity in definitions, monitoring practices, and study design. Despite increased awareness since 2014, high-quality prospective data are lacking. Standardized diagnostic criteria, systematic intra-abdominal pressure . | |