Controlled peritoneal drainage improves survival in children with abdominal compartment syndrome

BACKGROUND Children with massive ascites can develop abdominal compartment syndrome (ACS), which has been identified as an independent risk factor for mortality. OBJECTIVES The objective of this study was to assess the effectiveness of volume-controlled percutaneous catheter drainage (PCD) for treating children with massive ascites and ACS. METHODS A retrospective descriptive study was conducted; Comprising 12patients with ACS with massive ascites treated with volume-controlled PCD in a pediatric intensive care unitof a university hospital in southern China from April 2011 to June 2013. RESULTS The etiology of ascites in these children included abdominal tumor (8/12), capillary leak after liver or kidney transplantation (2/12) and urine leakage (2/12). Intra-abdominal hypertension was closely associated with multiple organ dysfunction and high mortality. Digestive and pulmonary functions were the most frequently affected by ACS, while the cerebrum was the least involved. Treatment with ultrasound-guided PCD significantly decreased intra-abdominal pressure, abdominal circumference, and indices of organ dysfunction. PCD treatment also significantly improved glomerular filtration rate and PaO2/FiO2. Complications of PCD included abdominal infection (1/12) and electrolyte imbalance (4/12). The mortality rate of patients treated with PCD was 25%, which was lower than previous reports. CONCLUSIONS Controlled peritoneal drainage is a minimally invasive and safe decompression method that is effective in patients with ACS, and should be considered in children with massive ascites.