A Prospective Randomised Evaluation of Intra-Abdominal Pressure With Crystalloid And Colloid Resuscitation in Burn Patients

Ashesh Kumar Jha; U.K Srivastav

Volume : VIII, Issue : IX, September - 2019

A Prospective Randomised Evaluation of Intra-Abdominal Pressure With Crystalloid And Colloid Resuscitation in Burn Patients

Ashesh Kumar Jha, U. K Srivastav

Abstract :

Introduction: Intra–abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can develop in burn patients due to overzealous fluid resuscitation, increased capillary permeability, loss of abdominal wall compliance and interstitial edema. Resuscitation protocol based on crystalloid regimen requires a substantial amount of fluid, therefore may be associated with a high rate of IAH and ACS. Colloid bases resuscitation regiment requires less amount of fluid, therefore, may confer protective effect against the development of IAH & ACS. Material & methods: Burn patients between 25% to 60% of total body surface area (TBSA) of burn within the age group of 18 to 60 years consenting to participate in this study were included. A total of 60 patients were randomized in two groups, with 30 each to either crystalloid or colloid based fluid regimen. Intra–abdominal pressure, urine output, blood urea nitrogen, serum creatinine, arterial blood gas analysis (PaO2, PCO2, Oxygen saturation, Base deficit), Liver function test in both study were measured at the time of admission and then 4 hourly for next 24 hours. Urinary bladder pressure was measured by the transurethral route using a foley catheter to assess the intra–abdominal pressure. Statistical analysis was done by using multiple hierarchical ANOVA followed by Tukey�s test. Results: The mean age of patients in the crystalloid group was 29.10�8.57, and in the colloid, group was 31.10�11.25. The mean total body surface area of burn (TBSA) in the crystalloid group was 42.90�9.12, and in the colloid group was 41.43�11.16 respectively. The mean amount of fluid used for resuscitation in the crystalloid group was 10485.67�2989.37ml, and the colloid group was 7019.50�1762.31ml. We did not come across any case of IAH or ACS in our study populations. During fluid resuscitation mean IAP at 4 hourly intervals for the next 24 hours were statistically not different in the crystalloid and the colloid group.(p=0.100) Conclusion: A large amount of fluid given during resuscitation may contribute to IAH or ACS in burn patients. However, it needs to be ascertained whether extensive fluid volume for resuscitation directly causes ACS. Despite the variably reported incidences of IAH & ACS in different literature, we did not come across any cases of IAH or ACS in our study group of the Indian population.