A 3-year-old boy with an 81% TBSA (total body surface area) burn developed bradycardia and his blood pressure became undetectable; he responded to atropine with a heart rate of 170/min and a detectable blood pressure. He arrived at a Shriners Burn Unit 13 hours after the burn, intubated, with a systolic blood pressure of 64 mm Hg, heart rate 180/min., temperature of 35.8E C, with only 4 to 6 ml of urine produced per hour. The child had massive edema and board-like tenseness of his abdominal cavity that made ventilation nearly impossible. Systolic blood pressure decreased to 24 mm Hg and was only mildly responsive to epinephrine. Arterial blood gases: pH 7.12, PaCO2 82 mm Hg, PaO2 49 mm Hg. The chest X-ray revealed marked displacement of the diaphragm superiorly. Bilateral chest and abdominal escharotomies were performed with no improvement. Because of persistent hypotension, midline laparotomy was performed in the intensive care unit. Large amounts of fluid were released under pressure from the peritoneal cavity. The viscera were packed with sterile moist dressings. In 9 minutes the systolic blood pressure had increased to 98 mm Hg, urine output increased and the patient stabilized. This is an example of the Abdominal Compartment Syndrome. Acute increases in abdominal pressure greater than 20 mm Hg frequently result in difficulties in ventilation, arterial hypotension, and oliguria. J Trauma 36:685, 1994. Measurement of abdominal pressure is easily performed using a Foley catheter. This technique has been successfully used, and pressures that rise greater than 25 mm Hg have been used as a criterion for operation or reoperation. This syndrome has been seen in penetrating abdominal trauma, vascular procedures, pulmonary lobectomies, low anterior colon resections, abdominal aortic aneurysm resections, and abdominal perineal resections. Ann Surg 199:28,1984.
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