Open Abdomen in Trauma and Critical Care

2017 ◽  
Vol 37 (5) ◽  
pp. 22-45 ◽  
Author(s):  
Eleanor R. Fitzpatrick
Keyword(s):  
Critical Care ◽  
Open Abdomen ◽  
Damage Control ◽  
Management Strategies ◽  
Damage Control Surgery ◽  
Standard Of Care ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Planned Reoperation

The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia. Determining the need for this potentially lifesaving intervention and managing the wound after the open abdomen has been created are all within the realm of critical care nurses. Case studies illustrate the implementation of the open abdomen technique and patient management strategies.

Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

2005 ◽  
Vol 71 (3) ◽  
pp. 219-224 ◽  
Author(s):  
JosÉ A. Montalvo ◽  
JosÉ A. Acosta ◽  
Pablo RodrÍguez ◽  
Kathia Alejandro ◽  
AndrÉs SÁrraga
Keyword(s):  
Surgical Complications ◽  
Causes Of Death ◽  
Surgical Complication ◽  
Damage Control ◽  
Multiple Logistic Regression Analysis ◽  
Hypovolemic Shock ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

scholarly journals Modified Opsite® Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience

2007 ◽  
Vol 89 (1) ◽  
pp. 57-61 ◽  
Author(s):  
JM Wilde ◽  
MA Loudon
Keyword(s):  
Critically Ill ◽  
Damage Control ◽  
Injured Patient ◽  
Damage Control Surgery ◽  
Traumatic Experience ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Operative Severity Score

INTRODUCTION Laparostomy techniques have advanced since the advent of damage control surgery for the critically injured patient. Numerous methods of temporary abdominal closure (TAC) are described in the literature with most reports focusing on trauma. We describe a modified technique for TAC and report its use in a series of critically ill non-trauma patients. PATIENTS AND METHODS Eleven patients under the care of one consultant underwent TAC over a 36-month period. A standardised technique was used in all cases and this is described. Severity of illness at the time of the first laparotomy was assessed using the Portsmouth variant of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). RESULTS Nineteen TACs were performed in 11 patients with a variety of serious surgical conditions. In-hospital mortality was zero despite seven of the patients having an individual P-POSSUM predicted mortality in excess of 50%. The laparostomy dressing proved simple in construction, facilitated nursing care and was well-tolerated in the critical care environment. All patients underwent definitive fascial closure during the index admission. CONCLUSIONS Laparostomy is a useful technique outwith the context of trauma. We have demonstrated the utility of the modified Opsite® sandwich vacuum pack for TAC in a series of critically ill patients with a universally favourable outcome. This small study suggests that selective use of TAC may reduce surgical mortality.

scholarly journals Management of Destructive Colon Injuries after Damage Control Surgery

2017 ◽  
Vol 31 (01) ◽  
pp. 036-040 ◽  
Author(s):  
Priya Prakash ◽  
William Symons ◽  
Jad Chamieh
Keyword(s):  
World War Ii ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Standard Of Care ◽  
Fecal Diversion ◽  
Trauma Patients ◽  
Stoma Formation ◽  
Diverting Stoma ◽  
Life Threatening ◽  
Colon Injuries

AbstractAfter the World War II, fecal diversion became the standard of care for colon injuries, although medical, logistic, and technical advancements have challenged this approach. Damage control surgery serves to temporize immediately life-threatening conditions, and definitive management of destructive colon injuries is delayed until after appropriate resuscitation. The bowel can be left in discontinuity for up to 3 days before edema ensues, but the optimal repair window remains within 12 to 48 hours. Delayed anastomosis performed at the take-back operation or stoma formation has been reported with variable results. Studies have revealed good outcomes in those undergoing anastomosis after damage control surgery; however, they point to a subgroup of trauma patients considered to be “high risk” that may benefit from fecal diversion. Risk factors influencing morbidity and mortality rates include hypotension, massive transfusion, the degree of intra-abdominal contamination, associated organ injuries, shock, left-sided colon injury, and multiple comorbid conditions. Patients who are not suitable for anastomosis by 36 hours after damage control may be best managed with a diverting stoma. Failures are more likely related to ongoing instability, and the management strategy of colorectal injury should be based mainly on the patient's overall condition.

Challenges in the Management of the Open Abdomen

ICU Director ◽  
2012 ◽  
Vol 4 (1) ◽  
pp. 33-39 ◽  
Author(s):  
David J. Worhunsky ◽  
Gregory Magee ◽  
David A. Spain
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Original Description ◽  
Fascial Closure ◽  
Critically Ill Patient ◽  
Temporary Abdominal Closure ◽  
Recurrence Rates ◽  
Abdominal Closure ◽  
Intra Abdominal Infection ◽  
Temporary Closure

First described more than 60 years ago, the open abdomen has now become a relatively common entity in surgical ICUs. Although the indications for an open abdomen have evolved since the original description of the damage control laparotomy, the goal remains to provide an unstable or critically ill patient time to correct their physiologic derangements. Temporary abdominal closure is thus used as a bridge to definitive repair and closure. Unfortunately, the open abdomen is associated with significant morbidity and mortality, and recent studies have suggested an overuse of the technique. Once the decision is made to proceed with an open abdomen, multiple options exist for temporary abdominal closure. The hope is to obtain definitive closure shortly thereafter in an attempt to reduce potential complications including intra-abdominal infection or enteroatmospheric fistula. Options for temporary closure range from the Bogotá bag to vacuum-assisted techniques; a combined technique of sequential fascial closure with vacuum assistance has recently been shown to result in 100% fascial approximation. In situations where fascial closure is unattainable, temporary coverage with a skin graft may be employed, followed by late abdominal closure via complex abdominal herniorrhaphy. Even using advanced methods such as component separation or a “pork sandwich” technique, the complication and recurrence rates remain high. A careful understanding of the indications, optimal management, and potential complications of the open abdomen is necessary to limit its overuse and ultimately reduce some of the challenges associated with it.

Trauma Patients with an Open Abdomen Following Damage Control Laparotomy can be Extubated Prior to Abdominal Closure

2018 ◽  
Vol 42 (10) ◽  
pp. 3210-3214 ◽  
Author(s):  
Joseph A. Sujka ◽  
Karen Safcsak ◽  
Michael L. Cheatham ◽  
Joseph A. Ibrahim
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Trauma Patients ◽  
Damage Control Laparotomy ◽  
Abdominal Closure

Negative pressure temporary abdominal closure without continuous suction: a solution for damage control surgery in austere and far-forward settings

2018 ◽  
Vol 165 (3) ◽  
pp. 163-165
Author(s):  
Edwin Robert Faulconer ◽  
A J Davidson ◽  
D Bowley ◽  
J Galante
Keyword(s):  
Supply Chain ◽  
Negative Pressure ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Topical Negative Pressure ◽  
Abdominal Closure ◽  
Potential Applications ◽  
Negative Pressure Dressings ◽  
Continuous Suction

The use of topical negative pressure dressings in temporary abdominal closure has been readily adopted worldwide; however, a method of continuous suction is typically required to provide a seal. We describe a method of temporary abdominal closure using readily available materials in the forward surgical environment which does not require continuous suction after application. This method of temporary abdominal closure provides the benefits of negative pressure temporary abdominal closure after damage control surgery without the need for continuous suction or specialised equipment. Its application in damage control surgery in austere or far-forward settings is suggested. The technique has potential applications for military surgeons as well as in humanitarian settings where the logistic supply chain may be fragile.

scholarly journals Indications for the Appropriate Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Derek Jason Roberts ◽  
Juan Duchesne ◽  
Megan L. Brenner ◽  
Bruno Pereira ◽  
Bryan A. Cotton ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Healthcare Resource Utilization ◽  
Trauma Patients ◽  
Appropriate Use ◽  
Initial Surgery ◽  
Civilian Trauma ◽  
Planned Reoperation

In patients undergoing emergent operation for trauma, surgeons must decide whether to perform a definitive or damage control (DC) procedure. DC surgery (abbreviated initial surgery followed by planned reoperation after a period of resuscitation in the intensive care unit) has been suggested to most benefit patients more likely to succumb from the “vicious cycle” of hypothermia, acidosis, and coagulopathy and/or postoperative abdominal compartment syndrome (ACS) than the failure to complete organ repairs. However, there currently exists no unbiased evidence to support that DC surgery benefits injured patients. Further, the procedure is associated with substantial morbidity, long lengths of intensive care unit and hospital stay, increased healthcare resource utilization, and possibly a reduced quality of life among survivors. Therefore, it is important to ensure that DC laparotomy is only utilized in situations where the expected procedural benefits are expected to outweigh the expected procedural harms. In this manuscript, we review the comparative effectiveness and safety of DC surgery when used for different procedural indications. We also review recent studies suggesting variation in use of DC surgery between trauma centers and the potential harms associated with overuse of the procedure. We also review published consensus indications for the appropriate use of DC surgery and specific abdominal, pelvic, and vascular DC interventions in civilian trauma patients. We conclude by providing recommendations as to how the above list of published appropriateness indications may be used to guide medical and surgical education, quality improvement, and surgical practice.

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