Iatrogenic chylothorax in major burn patient: case report and literature review.

Chylothorax is a potentially life-threatening form of pleural effusion containing lymphatic fluid. Its etiology may be either traumatic (either post-operative or a direct result of injury), a congenital abnormality of the thoracic duct, or non-traumatic. This is a case report of a left iatrogenic chylothorax, which developed 2 days after internal jugular vein catheterization, in a patient with 50% total body surface area (TBSA) burns. This complication was treated successfully by tube thoracostomy and oral supplementation with a low fat, high carbohydrate, high protein diet. Further the authors review the etiology, pathogenesis, clinical presentation and recommended management of catheter-related chylothorax.

Abdominal compartment syndrome monitoring in major burn patients with Siriraj device catheter.

Abdominal compartment syndrome (ACS) is consistently reported to have significant morbidity and mortality. Major burn patients who receive massive fluid resuscitation are at high-risk for this condition. Close monitoring of ACS is necessary for these patients. Prolonged unrelieved intra-abdominal pressure (IAP) at greater than 20 mmHg can produce significant morbidity and mortality. The most widely accepted and feasible way to measure IAP is via the draining port of a standard urinary catheter Siriraj burn unit developed its own device from simple equipment that can be found easily in the hospital. It proved to be useful, cheap, and effective in monitoring intra-abdominal pressure. The present study described techniques of using this device for monitoring and early detection of ACS. Five major burn patients > or = 40% Total body surface area (TBSA) was measured by IAP measurement via foley catheter using the Siriraj device catheter compared to direct measurement via peritoneal catheter. There was no difference of IAP between the two methods (p = 0.48). This suggested that Siriraj device catheter was useful, not invasive, and effective in reflection of actually IAP Siriraj burn unit suggested IAP measurement in all major burns > or = 40% TBSA to early recognize and treat intra-abdominal hypertension(IAH) that can lead to ACS. Early detection of this syndrome might decrease the adverse effects after increasing abdominal pressure that can cause organ dysfunction.