Relevance of intra-abdominal pressure monitoring in non-operative management of patients with blunt liver and splenic injuries.
10.1016/j.cjtee.2024.02.006
- Author:
Vivek KUMAR
1
;
Ramesh VAIDYANATHAN
2
;
Dinesh BAGARIA
2
;
Pratyusha PRIYADARSHINI
2
;
Abhinav KUMAR
2
;
Narendra CHOUDHARY
2
;
Sushma SAGAR
2
;
Amit GUPTA
2
;
Biplab MISHRA
2
;
Mohit JOSHI
2
;
Kapil Dev SONI
3
;
Richa AGGARWAL
3
;
Subodh KUMAR
4
Author Information
1. Department of Trauma and Emergency, All India Institute of Medical Sciences, Mihan, Nagpur, (Maharashtra), India.
2. Department of Trauma Surgery and Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
3. Department of Anaesthesia and Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
4. Department of Trauma Surgery and Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India. Electronic address: subodh6@gmail.com.
- Publication Type:Journal Article
- Keywords:
Abdominal compartment syndrome;
Blunt liver and splenic injuries;
Intra-abdominal hypertension;
Intra-abdominal pressure;
Non-operative management
- MeSH:
Humans;
Male;
Adult;
Female;
Wounds, Nonpenetrating/physiopathology*;
Spleen/injuries*;
Prospective Studies;
Cross-Sectional Studies;
Liver/injuries*;
Middle Aged;
Monitoring, Physiologic/methods*;
Pressure;
Abdominal Injuries/physiopathology*;
Intra-Abdominal Hypertension;
Young Adult
- From:
Chinese Journal of Traumatology
2025;28(4):307-312
- CountryChina
- Language:English
-
Abstract:
PURPOSE:Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury.
METHOD:A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q1, Q3) as indicated. χ2 or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance.
RESULTS:Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention.
CONCLUSION:As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.
