Orbital compartment syndrome following major burn resuscitation: a case series and survey of practice patterns.

BACKGROUND Orbital compartment syndrome (OCS) is a rare but devastating complication of over-resuscitation in burn patients that may lead to permanent visual loss. The purpose of this study was to (1) present a series of burn patients with OCS, and (2) survey practice patterns of monitoring intra-ocular pressure (IOP) during burn resuscitation. METHODS Cases of OCS at two American Burn Association (ABA)-verified burn centers were retrospectively reviewed. Patients were included if they (a) required lateral canthotomy/cantholysis for elevated IOPs, or (b) developed blindness during admission unrelated to any other ocular pathology. Data was collected on demographics, burn characteristics, fluid administration, ophthalmologic findings and complications. An eight-item electronic survey was distributed by email through the ABA to all physician members. RESULTS Twelve patients with OCS were identified, with a mean age of 47.8 ±12.4 years and TBSA of 63.7 ±18.6%. Mean fluid resuscitation at 24 hours was 4.9 ±1.6 mL/kg/%TBSA, or 0.29 ±0.06 L/kg. Eight patients underwent canthotomy/cantholysis for OCS, while four were later found to have visual loss. A total of 83 (14%) ABA physicians responded to the survey. IOP was routinely measured by 23% of respondents during acute burn resuscitation. CONCLUSIONS OCS appears to have developed despite a relatively low 24-hour mL/kg/% burn resuscitation volume, but with a relatively higher cumulative (L/kg) fluid volume. Our survey found that monitoring of IOP during burn resuscitation is not routinely performed by the majority of providers. Taken together, the present study suggests clinical guidelines to recognize this complication of over-resuscitation.