| Authors: Mark J. Kaplan, Eileen Brunwasser, Veneet Mehan, Katie Ugolini, Stephanie Fuller, Adrian Finol, Ian Soriano, |
| Abstract: Introduction: Intra-abdominal hypertension (IAH) and the Abdominal Compartment Syndrome (ACS) are recognized as significant complications in abdominal trauma. The incidence of ACS has increased with the use of damage control surgery (DCS), packing and increased survival of trauma patients. Prevention of IAH and ACS has been shown to lower the associated complications and mortality. Reported techniques have been successful in controlling the open abdomen, but have been partially effective in reducing the risk of ACS. A vacuum assisted wound management system (VAWMS; V.A.C. ®, KCI, San Antonio) has been shown to be effective in managing open abdomens. This study will evaluate the effectiveness of VAWMS in the treatment and prevention of ACS and underlying IAH in posttraumatic patients with open abdomens.
Methods: A retrospective study comparing the effectiveness of VAWMS to standard Vac. pack therapy (VPT, polyurethane coverage of bowel with drains connected to wall suction) in trauma patents with open abdomens were studied over a 2-year period from 1/01/2001 to12/30/2003. Inclusion criteria was defined as patients with a high risk of developing pathologic IAH>25mmHG or ACS: admission lactate>30 mg%; base deficit>-5.0; pH<7.25, DCS, and significant bowel edema. In-hospital deaths were excluded. Patients were evaluated for effectiveness with comparison of: ventilator days, ICU LOS, hospital LOS, time to closure, the incidence of ACS and IAH. Also complications will be compared.
Results: Of the 1833 patients admitted in this time period 19 patients were treated with open abdomens and were identified at risk for IAH or ACS. Eleven patients were treated with VAWMS and 8 patients with VPT and were from penetrating trauma. Groups were matched for ISS, based deficit, age. There were no patients in the VAWMS group that developed pathologic IAH or ACS vs. a 50% rate in the VPT group. In the VAWMS group 78% of patients were primarily closed in mean time of 12 days; the VPT group had a mean closure rate of 12% in a mean time of 23 days. ARDS was noted in 50% of patients with VPT and 9% in patients with VAWM.
Conclusions: This retrospective study demonstrates the effectiveness of VAWMS in the management of the open abdomen and possible prevention of IAH and ACS. There was also a significant reduction in complications associated with open abdomen. The effectiveness was related to the reduction in edema, increased blood flow, effective management of third space fluid, and improved rates of closure.
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