Patients suffering major burn injury develop an inflammatory cascade that is "ideal" for developing intra-abdominal hypertension. Because of the massive inflammatory response that occurs in burn patients a major capillary leak develops. This is clearly manifested by the fluid requirements of these patients and by the external edema that is visible in all major burns. While the external edema is readily apparent, capillary leak and edema in the bowel wall as well as sequestration of cytokine rich free fluid within the peritoneal cavity is also substantial.[1] The end result is a very high incidence of intra-abdominal hypertension in major burn cases with prospective studies demonstrating abdominal compartment syndrome in 70% of major burns.[2]

Burn patients with IAH may respond to unique treatment modalities. If they have torso burns, the initial treatment for rising IAP may be escharotomy, allowing the abdominal cavity to expand and reducing the abdominal pressure.[3, 4] Another common intervention is percutaneous drainage of fluid out of the peritoneal cavity. Since these patients have such and aggressive capillary leak they tend to leak fluid into the abdominal cavity that can be removed using paracentesis. Multiple authors describe successful reduction of intra-abdominal pressure in burn patients treated with paracentesis as well as from leaving an indwelling peritoneal drain catheter.[5-7] Colloid replacement instead of saline for fluid requirements is also of potential therapeutic interest in burn patients.[8]

1. Kowal-Vern, A., et al., Elevated cytokine levels in peritoneal fluid from burned patients with intra-abdominal hypertension and abdominal compartment syndrome. Burns, 2006.
2. Ivy, M.E., et al., Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma, 2000. 49(3): p. 387-91.
3. Tsoutsos, D., et al., Early Escharotomy as a Measure to Reduce Intraabdominal Hypertension in Full-Thickness Burns of the Thoracic and Abdominal Area. World J Surg, 2003.
4. Oda, J., et al., Effects of escharotomy as abdominal decompression on cardiopulmonary function and visceral perfusion in abdominal compartment syndrome with burn patients. J Trauma, 2005. 59(2): p. 369-74.
5. Latenser, B.A., et al., A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil, 2002. 23(3): p. 190-5.
6. Corcos, A.C. and H.F. Sherman, Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma, 2001. 51(6): p. 1062-4.
7. Parra, M.W., et al., Paracentesis for resuscitation-induced abdominal compartment syndrome: an alternative to decompressive laparotomy in the burn patient. J Trauma, 2006. 60(5): p. 1119-21.
8. O'Mara, M.S., et al., A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma, 2005. 58(5): p. 1011-8.