| Abstract: Background: Abdominal compartment syndrome (ACS) is recognized as a cause of multiorgan system failure (MOSF) (1). Abdominal decompression can be achieved by laparotomy or paracentesis in cases where ascites plays a contributory role (2). Rapid decompression can lead to hemodynamic instability, primarily hypotension (3). Therefore, regulated peritoneal fluid drainage over hours to days should decrease the incidence of associated hemodynamic instability.
Aims: We report our experience using unregulated (single aspiration or gravity drainage) versus regulated (drain placed 0-10 cm H20 above the umbilicus) paracentesis in pediatric patients with ACS.
Method: A retrospective chart review of 17 paracentesis procedures performed in 14 patients (4mos-16yrs) between 01/1999 through 05/2004 in a tertiary PICU is reported. We defined ACS as abdominal distension associated with mechanical ventilation, urine output <0.5ml/kg/hr, and hemodynamic instability requiring fluid boluses and/or inotropic support. Outcome measures at 24 hours included associated bleeding, bowel perforation, hypotension, dysrhythmias, mortality, improved diuresis, and decreased FiO2, pressors, and/or fluid bolus requirements.
Results: 8 of 14 patients that underwent paracentesis met ACS criteria. Of those patients, 3 underwent regulated paracentesis and 5 had unregulated paracentesis. 42±16% (mean ± standard deviation) of the 24hr peritoneal fluid (36±34ml/kg/24hrs) was drained in the first 2hrs in regulated paracentesis patients (RPP) versus 90±18% of 41±59ml/kg/24hrs in the unregulated paracentesis patients (UPP). At 24hrs, 3/5 UPP had decreased FiO2 (0.79±0.25 to 0.47±0.06) versus 2/3 RPP (0.93±0.12 to 0.48±0.04). Similarly, 5/5 UPP versus 0/3 RPP had increased urine output (>0.5cc/kg/hr). However, 3/5 UPP had hypotension and/or dysrhythmias in the first 24hrs and one death versus 1/3 RPP with dysrhythmia and no death. All patients required fluid boluses prior to ACS drainage but only 1/4 UPP versus 3/3 RPP required boluses at 24hrs. For patients on pressors, 2/3 RPP and 1/3 UPP had pressors weaned by 24hrs.
Conclusion: Greater reversal of MOSF was observed in UPP compared to RPP at 24hrs. However, more complications occurred in UPP.
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