Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum

  • Lee, Gil Jae (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center) ;
  • Lee, Min A (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center) ;
  • Yoo, Byungchul (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center) ;
  • Park, Youngeun (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center) ;
  • Jang, Myung Jin (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center) ;
  • Choi, Kang Kook (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
  • Received : 2020.03.20
  • Accepted : 2020.03.24
  • Published : 2020.03.30
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Abstract

Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. Methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy. Results: The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay. Conclusions: PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.

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References

  1. van Waes JA, van Klei WA, Wijeysundera DN, van Wolfswinkel L, Lindsay TF, Beattie WS. Association between intraoperative hypotension and myocardial injury after vascular surgery. Anesthesiology 2016;124:35-44. https://doi.org/10.1097/ALN.0000000000000922
  2. Limburg M, Wijdicks EF, Li H. Ischemic stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology 1998;50:895-901. https://doi.org/10.1212/WNL.50.4.895
  3. Poulton T, Murray D; National Emergency Laparotomy Audit (NELA) project team. Pre-optimisation of patients undergoing emergency laparotomy: a review of best practice. Anaesthesia 2019;74 Suppl 1:100-7. https://doi.org/10.1111/anae.14514
  4. Marsden M, Carden R, Navaratne L, Smith IM, Penn-Barwell JG, Kraven LM, et al. Outcomes following trauma laparotomy for hypotensive trauma patients: a UK military and civilian perspective. J Trauma Acute Care Surg 2018;85:620-5. https://doi.org/10.1097/TA.0000000000001988
  5. Cottingham CA. Resuscitation of traumatic shock: a hemodynamic review. AACN Adv Crit Care 2006;17:317-26. https://doi.org/10.1097/01256961-200607000-00011
  6. Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care 2005;9(Suppl 5):S1-9. https://doi.org/10.1186/cc3779
  7. Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD. Epidemiology of trauma deaths. Am J Surg 1980;140:144-50. https://doi.org/10.1016/0002-9610(80)90431-6
  8. Acosta JA, Yang JC, Winchell RJ, Simons RK, Fortlage DA, Hollingsworth-Fridlund P, et al. Lethal injuries and time to death in a level I trauma center. J Am Coll Surg 1998;186:528-33. https://doi.org/10.1016/S1072-7515(98)00082-9
  9. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW Jr, et al. The major trauma outcome study: establishing national norms for trauma care. J Trauma 1990;30:1356-65. https://doi.org/10.1097/00005373-199011000-00008
  10. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995;38:185-93. https://doi.org/10.1097/00005373-199502000-00006
  11. Potenza BM, Hoyt DB, Coimbra R, Fortlage D, Holbrook T, Hollingsworth-Fridlund P; Trauma Research and Education Foundation. The epidemiology of serious and fatal injury in San Diego County over an 11-year period. J Trauma 2004;56:68-75. https://doi.org/10.1097/01.TA.0000101490.32972.9F
  12. Hunt L, Frost SA, Hillman K, Newton PJ, Davidson PM. Management of intra-abdominal hypertension and abdominal compartment syndrome: a review. J Trauma Manag Outcomes 2014;8:2. https://doi.org/10.1186/1752-2897-8-2
  13. Lee RK. Intra-abdominal hypertension and abdominal compartment syndrome: a comprehensive overview. Crit Care Nurse 2012;32:19-31. https://doi.org/10.4037/ccn2012662
  14. Wauters J, Claus P, Brosens N, McLaughlin M, Hermans G, Malbrain M, et al. Relationship between abdominal pressure, pulmonary compliance, and cardiac preload in a porcine model. Crit Care Res Pract 2012;2012:763181. https://doi.org/10.1155/2012/763181
  15. Maffongelli A, Fazzotta S, Palumbo VD, Damiano G, Buscemi S, Maione C, et al. Abdominal compartment syndrome: diagnostic evaluation and possible treatment. Clin Ter 2020;171:e156-60.