Prevalence, Predictors and Decompressive Laparotomy in Abdominal Compartment Syndrome in Patients Requiring Extracorporeal Membrane Oxygenation
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Subjects
2.2. ECMO Management
2.3. Abdominal Compartment Syndrome
2.4. Conservative and Surgical Treatment of Abdominal Compartment Syndrome
2.5. Statistics
3. Results
3.1. Prevalence of Abdominal Compartment Syndrome in ECMO Patients
3.2. Factors Associated with Abdominal Compartment Syndrome in ECMO Patients
3.3. Decompressive Laparotomy and Outcome for Abdominal Compartment Syndrome in ECMO Patients
4. Discussion
4.1. Prevalence of Abdominal Compartment Syndrome in ECMO Patients
4.2. Factors Associated with Abdominal Compartment Syndrome in ECMO Patients
4.3. Decompressive Laparotomy and Outcome for Abdominal Compartment Syndrome in ECMO Patients
4.4. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ACS | abdominal compartment syndrome |
BMI | body mass index |
CPC | cerebral performance category |
DL | decompressive laparotomy |
ECMO | extracorporeal membrane oxygenation |
IAH | intra-abdominal hypertension |
IAP | intra-abdominal pressure |
ICU | intensive care unit |
SOFA | sequential organ failure assessment |
VA | veno-arterial |
VV | Veno-venous |
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Variables | No Abdominal Compartment Syndrome (n = 1596) | Abdominal Compartment Syndrome (n = 47) | p-Value |
---|---|---|---|
Age, years | 57 [47; 66] | 58 [48; 67] | 0.978 |
Male sex | 1111 (70%) | 35 (74%) | 0.475 |
BMI, kg/m2 | 27.0 [24.2; 31.1] | 27.7 [23.9; 35.6] | 0.331 |
Temperature, °C | 35.0 [33.5; 36.2] | 33.9 [32.5; 35.4] | 0.002 |
ECMO mode, VA | 913 (57%) | 31 (66%) | 0.232 |
SOFA | 14 [11; 17] | 17 [14; 19] | <0.001 |
Resuscitation | 734 (46%) | 32 (68%) | 0.003 |
Renal replacement therapy | 283 (18%) | 13 (28%) | 0.081 |
Mean arterial pressure, mmHg | 61 [45; 70] | 55 [40; 65] | 0.032 |
Norepinephrine, µg/kg/min | 0.30 [0.12; 0.60] | 0.51 [0.00; 0.97] | 0.080 |
paO2/FiO2, mmHg | 77 [60; 127] | 70 [56; 100] | 0.086 |
Minute ventilation, L/min | 9.0 [6.0; 11.4] | 8.0 [5.0; 11.5] | 0.298 |
Tidal volume, mL | 460 [417; 560] | 450 [427; 556] | 0.249 |
Respiratory rate, /min | 18 [13; 23] | 17 [11; 22] | 0.259 |
Peak inspiratory pressure, cmH2O | 30 [24; 35] | 30 [25; 38] | 0.225 |
Positive end-expiratory pressure, cmH2O | 12 [9; 15] | 13 [9; 15] | 0.394 |
pH | 7.22 [7.14; 7.32] | 7.14 [7.01; 7.22] | <0.001 |
Lactate, mg/dL | 50 [18; 99] | 94 [56; 157] | <0.001 |
Activated partial thromboplastin time, s | 45 [35; 70] | 72 [42; 120] | <0.001 |
D-Dimer, mg/L | 7 [3; 20] | 14 [6; 34] | 0.001 |
Fibrinogen, mg/dL | 349 [215; 540] | 185 [109; 354] | <0.001 |
Platelets, 109/L | 176 [116; 251] | 167 [92;212] | 0.073 |
C-reactive protein, mg/L | 57 [11; 165] | 34.5 [3; 132] | 0.108 |
Procalcitonin, µg/L | 3.5 [1.0; 13.2] | 47.0 [14.0; 93.0] | <0.001 |
Interleukin-6, pg/mL | 401 [112; 1703] | 1673 [367; 18300] | 0.001 |
Interleukin-8, pg/mL | 107 [40; 346] | 407 [57; 2154] | 0.006 |
Lactate dehydrogenase, U/L | 438 [278; 744] | 511 [347; 809] | 0.262 |
Aspartate aminotransferase, U/L | 98 [44; 288] | 149 [69; 406] | 0.080 |
Plasma free hemoglobin, mg/L | 101 [46; 273] | 298 [127; 599] | <0.001 |
Variables | OR (95% CI) | p-Value |
---|---|---|
SOFA | 1.040 (0.807; 1.340) | 0.764 |
Temperature, °C | 0.813 (0.604; 1.096) | 0.175 |
Lactate, mg/dL | 1.006 (0.994; 1.018) | 0.339 |
Fibrinogen, mg/dL | 1.001 (0.998; 1.005) | 0.429 |
Procalcitonin, µg/L | 1.024 (1.006; 1.042) | 0.008 |
Variable | N | No Decompressive Laparotomy (n = 21) | N | Decompressive Laparotomy (n = 26) | p-Value |
---|---|---|---|---|---|
Intra-abdominal pressure, mmHg | 0.001 | ||||
III (21–25 mmHg) | 12 | 12 (57%) | 3 | 3 (12%) | |
IV (>25 mmHg) | 9 | 9 (43%) | 23 | 23 (88%) | |
Age, years | 21 | 59 [48; 66] | 26 | 58 [46; 67] | 0.923 |
Male sex | 21 | 17 (81%) | 26 | 18 (69%) | 0.360 |
BMI, kg/m2 | 21 | 29.4 [26.0; 37.0] | 25 | 27.5 [23.7; 36.9] | 0.434 |
SOFA at ICU admission | 14 | 16 [13; 17] | 21 | 18 [15; 20] | 0.048 |
Temperature, °C | 14 | 36.8 [33.9; 37.1] | 25 | 34.8 [33.3; 35.5] | 0.022 |
Abdominal perfusion pressure, mmHg | 21 | 40 [33; 53] | 23 | 36 [25; 49] | 0.169 |
Mean arterial pressure, mmHg | 21 | 68 [60; 78] | 23 | 67 [55; 79] | 0.851 |
Epinephrine, µg/kg/min | 20 | 0.05 [0.00; 0.11] | 23 | 0.10 [0.00; 0.17] | 0.163 |
Norepinephrine, µg/kg/min | 21 | 0.14 [0.00; 0.31] | 22 | 0.07 [0.00; 0.19] | 0.595 |
Resuscitation | 21 | 15 (71%) | 26 | 21 (81%) | 0.452 |
pO2/FiO2, mmHg | 16 | 153 [85; 296] | 18 | 133 [85; 208] | 0.551 |
Minute ventilation, L/min | 20 | 3.9 [2.9; 5.3] | 21 | 3.4 [1.6; 6.1] | 0.382 |
Tidal volume, mL | 20 | 335.5 [207.8; 401.5] | 21 | 214.0 [73.5; 322.0] | 0.039 |
Respiratory rate, /min | 20 | 13 [10; 17] | 18 | 16 [14; 20] | 0.051 |
Peak inspiratory pressure, cmH2O | 20 | 27.0 [23.0; 30.8] | 21 | 30.0 [27.5; 34.0] | 0.036 |
Positive end-expiratory pressure, cmH2O | 19 | 14 (11.8; 20] | 21 | 15.0 [13.7; 20.0] | 0.486 |
Respiratory system compliance, mL/cmH2O | 18 | 34.0 [10.8; 38.8] | 19 | 19.5 [3.0; 30.0] | 0.046 |
Acute liver failure | 21 | 2 (10%) | 26 | 9 (35%) | 0.081 |
Acute renal failure | 21 | 9 (43%) | 26 | 22 (85%) | 0.003 |
Net volume until ACS, mL | 21 | 2134 [74; 4799] | 16 | 3867 [1898; 7219] | 0.066 |
pH | 21 | 7.40 [7.30; 7.40] | 22 | 7.30 [7.20; 7.48] | 0.570 |
Lactate, mg/dL | 21 | 99 [21; 137] | 23 | 88 [43; 152] | 0.365 |
ECMO flow, L/min | 21 | 3.3 [3; 3.5] | 23 | 3.5 [3.0; 3.9] | 0.424 |
Days on ECMO | 21 | 5 [2; 8] | 26 | 4 [2; 7] | 0.644 |
PRBCs per day on ECMO support | 21 | 1.0 [0.2; 2.3] | 26 | 1.6 [0.4; 3.5] | 0.371 |
Platelets transfusions per day on ECMO support | 21 | 0 [0; 0] | 26 | 0 [0; 0] | 0.422 |
Variable | n | Before Decompressive Laparotomy | n | After Decompressive Laparotomy | p-Value |
---|---|---|---|---|---|
Intra-abdominal pressure, mmHg | 26 | 30 [28;35] | 11 | 24 [19; 29] | 0.027 |
Minute ventilation, L/min | 21 | 3.3 [1.4; 5.5] | 22 | 4.5 [2.5; 7.2] | 0.015 |
Tidal volume, mL | 21 | 227 [113; 349] | 22 | 341 [183; 444] | 0.006 |
Respiratory Rate, /min | 21 | 15 [14; 19] | 22 | 15 [13; 19] | 0.894 |
Peak inspiratory pressure, cmH2O | 21 | 31.0 [29.0; 35.0] | 21 | 30.0 [28.0; 33.0] | 0.139 |
Positive end-expiratory pressure, cmH2O | 21 | 18.6 [15.7; 20.3] | 21 | 18.0 [15.4; 20.1] | 0.440 |
Driving pressure, cmH2O | 20 | 14.4 [11.0; 15.4] | 20 | 12.7 [10.0; 15.4] | 0.221 |
Compliance, mL/cmH2O | 19 | 12.0 [3.0; 29.0] | 19 | 24.0 [7.0; 34.5] | 0.005 |
ECMO blood flow, L/min | 25 | 3.5 [3.0; 3.9] | 25 | 3.5 [3.0; 4.0] | 0.373 |
Epinephrine, µg/kg/min | 26 | 0.07 [0.00; 0.12] | 22 | 0.00 [0.00; 0.07] a | 0.344 |
Norepinephrine, µg/kg/min | 26 | 0.08 [0.00; 0.19] | 22 | 0.00 [0.00; 0.13] a | 0.109 |
Mean arterial pressure, mmHg | 24 | 70 [60; 94] | 22 | 68 [59; 75] a | 0.126 |
Lactate, mg/dL | 12 | 76 [38; 119] | 24 | 30 [19; 78] a | 0.059 |
Urine volume, mL/h | 24 | 30 [11; 140] | 24 | 36 [13; 177] | 0.173 |
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Lubnow, M.; Koch, C.T.; Malfertheiner, M.V.; Foltan, M.; Philipp, A.; Lunz, D.; Schlitt, H.J.; Brennfleck, F.; Dietl, B.; Hamer, O.W.; et al. Prevalence, Predictors and Decompressive Laparotomy in Abdominal Compartment Syndrome in Patients Requiring Extracorporeal Membrane Oxygenation. J. Clin. Med. 2025, 14, 855. https://doi.org/10.3390/jcm14030855
Lubnow M, Koch CT, Malfertheiner MV, Foltan M, Philipp A, Lunz D, Schlitt HJ, Brennfleck F, Dietl B, Hamer OW, et al. Prevalence, Predictors and Decompressive Laparotomy in Abdominal Compartment Syndrome in Patients Requiring Extracorporeal Membrane Oxygenation. Journal of Clinical Medicine. 2025; 14(3):855. https://doi.org/10.3390/jcm14030855
Chicago/Turabian StyleLubnow, Matthias, Chiara T. Koch, Maximilian V. Malfertheiner, Maik Foltan, Alois Philipp, Dirk Lunz, Hans J. Schlitt, Frank Brennfleck, Barbara Dietl, Okka W. Hamer, and et al. 2025. "Prevalence, Predictors and Decompressive Laparotomy in Abdominal Compartment Syndrome in Patients Requiring Extracorporeal Membrane Oxygenation" Journal of Clinical Medicine 14, no. 3: 855. https://doi.org/10.3390/jcm14030855
APA StyleLubnow, M., Koch, C. T., Malfertheiner, M. V., Foltan, M., Philipp, A., Lunz, D., Schlitt, H. J., Brennfleck, F., Dietl, B., Hamer, O. W., Stadlbauer, A., Schmid, C., Zeman, F., Müller, T., & Fisser, C. (2025). Prevalence, Predictors and Decompressive Laparotomy in Abdominal Compartment Syndrome in Patients Requiring Extracorporeal Membrane Oxygenation. Journal of Clinical Medicine, 14(3), 855. https://doi.org/10.3390/jcm14030855