Secondary abdominal compartment syndrome in patients with toxic epidermal necrolysis

Introduction: Secondary abdominal compartment syndrome (ACS) is a severe complication in patients admitted to burn intensive care units (BICUs). Unlike patients with thermal burns, patients with toxic epidermal necrolysis (TEN) present with a different pathophysiology and usually require less fluid. Patients and methods: We reviewed our registry of adult patients presenting with TEN in our 8-bed BICU over the course of 11 years and identified and analyzed patients treated for ACS and decompressive laparotomy (DL). Results: From a total of 29 patients with bioptic confirmed TEN, 5 underwent DL due to ACS with a mean age of 57 years, mean percentage of total body surface area (TBSA) affected of 54 +/- 25%, complete epidermolysis of 28 +/- 24% TBSA, a mean severity of illness score (SCORTEN) of 3.8 +/- 0.8, and a mean intra-abdominal pressure before DL of 33 +/- 7 mmHg. Mortality was 100% in patients with ACS versus 33% without ACS. Conclusion: An ACS that requires DL worsens the already critical condition of a TEN patient considerably. TEN-related impaired intestinal functionality and increasing intestinal edema due to systemic capillary leakage warrant early initiation of intra-abdominal pressure monitoring to identify patients at high risk of ACS. (C) 2011 Elsevier Ltd and ISBI. All rights reserved.