Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 2/2022

17.11.2020 | Original Article

Open abdomen in the trauma ICU patient: who? when? why? and what are the outcome results?

verfasst von: Kurt Nirishan Boolaky, Ali Hassan Tariq, Timothy Craig Hardcastle

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Temporary abdominal closure is a component of damage control surgery and may decrease mortality rates. The ultimate aim in managing an open abdomen is to achieve definitive fascial closure. The aim of this study is to assess the previously known predictors for failure to achieve definitive fascial closure and identify new predictors in order to achieve a better outcome.

Methods

An 11-year retrospective chart review included open abdomen cases at Inkosi Albert Luthuli Hospital Trauma ICU in KZN (Ethics Approval BCA207-09). The evaluated outcomes were definitive fascial closure, open abdomen and mortality. Variables included age, co-morbidities, albumin levels, renal failure, multiple blood transfusions, type of blood products given, entero-atmospheric fistulas, TAC, anastomosis, intra-abdominal abscess, type of nutrition, ACS, number of re-laparotomies, deep site infections (peritonitis), systemic infections (bloodstream), ventilator acquired pneumonia, head injury, and type of fluids given.

Results

This study reviewed 188 cases, 46.8% (88) arrived from elsewhere with an open abdomen while 53.2% (100) did not; 46.8% suffered blunt trauma, 45.2% suffered gunshots, while 8.0% were stabbed. Ninety deaths (47.9%) occurred during the index admission with 57 (30.3%) within the first 30 days. For both death within 30 days and death as final outcome, the majority were blunt abdominal trauma, 51.1 and 52.6%, respectively. Out of 188 patients, 27.1% had definitive fascial closure and 26.6% remained with an open abdomen. The relevant variables related to failure to achieve fascial closure were hypoalbuminemia (p = 0.002, p = 0.036), anastomotic leak (p < 0.05), VAP (p = 0.007), age (p = 0.002), intra-abdominal abscesses (p = 0.006), ACS (p = 0.005), multiple re-laparotomies (p = 0,028), deep surgical site infection (p < 0.05) and multi-organ failure (p = 0.003).

Conclusion

This study identified the predictors of failed fascial closure and mortality. While not directly modifiable, hypoalbuminaemia, anastomotic leak and sepsis, leading to multiple re-laparotomy, preclude early closure and portend high mortality.
Literatur
1.
Zurück zum Zitat Chabot E, Nirula R. Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management. Trauma Surg Acute Care Open. 2017;2(1):e000063.CrossRef Chabot E, Nirula R. Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management. Trauma Surg Acute Care Open. 2017;2(1):e000063.CrossRef
2.
Zurück zum Zitat Leppäniemi A. Who invented damage control surgery? Scand J Surg. 2014;103:165–6.CrossRef Leppäniemi A. Who invented damage control surgery? Scand J Surg. 2014;103:165–6.CrossRef
3.
Zurück zum Zitat Coccolini F, Roberts D, Ansaloni L, Ivatury R, Gamberini E, Kluger Y, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J EmergSurg. 2018;13:1–16.CrossRef Coccolini F, Roberts D, Ansaloni L, Ivatury R, Gamberini E, Kluger Y, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J EmergSurg. 2018;13:1–16.CrossRef
4.
Zurück zum Zitat Hu P, Uhlich R, Gleason F, Kerby J, Bosarge P. Impact of initial temporary abdominal closure in damage control surgery: a retrospective analysis. World J EmergSurg. 2018;13:43.CrossRef Hu P, Uhlich R, Gleason F, Kerby J, Bosarge P. Impact of initial temporary abdominal closure in damage control surgery: a retrospective analysis. World J EmergSurg. 2018;13:43.CrossRef
5.
Zurück zum Zitat Huang Q, Li J, Lau W-y. Techniques for abdominal wall closure after damage control laparotomy: from temporary abdominal closure to early/delayed fascial closure—a review. Gastroenterol Res Pract. 2016;2016:2073260.PubMed Huang Q, Li J, Lau W-y. Techniques for abdominal wall closure after damage control laparotomy: from temporary abdominal closure to early/delayed fascial closure—a review. Gastroenterol Res Pract. 2016;2016:2073260.PubMed
6.
Zurück zum Zitat Schein M, Saadia R, Jamieson JR, Decker GA. The “sandwich technique” in the management of the open abdomen. Br J Surg. 1986;73(5):369–70.CrossRef Schein M, Saadia R, Jamieson JR, Decker GA. The “sandwich technique” in the management of the open abdomen. Br J Surg. 1986;73(5):369–70.CrossRef
7.
Zurück zum Zitat Jakob MO, Schwarz C, Haltmeier T, Zindel J, Pinworasarn T, Candinas D, et al. Mesh-augmented versus direct abdominal closure in patients undergoing open abdomen treatment. Hernia. 2018;22(5):785–92.CrossRef Jakob MO, Schwarz C, Haltmeier T, Zindel J, Pinworasarn T, Candinas D, et al. Mesh-augmented versus direct abdominal closure in patients undergoing open abdomen treatment. Hernia. 2018;22(5):785–92.CrossRef
9.
Zurück zum Zitat Du Toit A. Nutritional management of a patient with an open abdomen: SASPEN case study. South African J ClinNutr. 2014;27(3):133–8.CrossRef Du Toit A. Nutritional management of a patient with an open abdomen: SASPEN case study. South African J ClinNutr. 2014;27(3):133–8.CrossRef
10.
Zurück zum Zitat Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Nirula R, et al. Who should we feed? Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. J Trauma Acute Care Surg. 2012;73(6):1380–7 (discussion 7-8).CrossRef Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Nirula R, et al. Who should we feed? Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. J Trauma Acute Care Surg. 2012;73(6):1380–7 (discussion 7-8).CrossRef
11.
Zurück zum Zitat Klein Y. Closure of the open abdomen: a practical approach. Curr Trauma Rep. 2016;2(4):196–201.CrossRef Klein Y. Closure of the open abdomen: a practical approach. Curr Trauma Rep. 2016;2(4):196–201.CrossRef
12.
Zurück zum Zitat Loftus T, Jordan J, Croft C, Smith R, Efron P, Moore F, et al. Characterization of hypoalbuminemia following temporary abdominal closure. J Trauma Acute Care Surg. 2017;83:1.CrossRef Loftus T, Jordan J, Croft C, Smith R, Efron P, Moore F, et al. Characterization of hypoalbuminemia following temporary abdominal closure. J Trauma Acute Care Surg. 2017;83:1.CrossRef
14.
Zurück zum Zitat Georgoff P, Perales P, Laguna B, Holena D, Reilly P, Sims C. Colonic injuries and the damage control abdomen: does management strategy matter? J Surg Res. 2013;181(2):293–9.CrossRef Georgoff P, Perales P, Laguna B, Holena D, Reilly P, Sims C. Colonic injuries and the damage control abdomen: does management strategy matter? J Surg Res. 2013;181(2):293–9.CrossRef
15.
Zurück zum Zitat Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Crowell K, et al. Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen. J Trauma. 2011;70(2):273–7.PubMed Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Crowell K, et al. Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen. J Trauma. 2011;70(2):273–7.PubMed
16.
Zurück zum Zitat Collier B, Guillamondegui O, Cotton B, Donahue R, Conrad A, Groh K, et al. Feeding the open abdomen. JPEN J Parenter Enteral Nutr. 2007;31:410–5.CrossRef Collier B, Guillamondegui O, Cotton B, Donahue R, Conrad A, Groh K, et al. Feeding the open abdomen. JPEN J Parenter Enteral Nutr. 2007;31:410–5.CrossRef
17.
Zurück zum Zitat Löfgren E, Mabesa T, Hammarqvist F, Hardcastle T. Early enteral nutrition compared to outcome in critically ill trauma patients at a level one trauma centre. South African J ClinNutr. 2015;28(2):70–6.CrossRef Löfgren E, Mabesa T, Hammarqvist F, Hardcastle T. Early enteral nutrition compared to outcome in critically ill trauma patients at a level one trauma centre. South African J ClinNutr. 2015;28(2):70–6.CrossRef
18.
Zurück zum Zitat Byrnes MC, Reicks P, Irwin E. Early enteral nutrition can be successfully implemented in trauma patients with an “open abdomen.” Am J Surg. 2010;199(3):359–63.CrossRef Byrnes MC, Reicks P, Irwin E. Early enteral nutrition can be successfully implemented in trauma patients with an “open abdomen.” Am J Surg. 2010;199(3):359–63.CrossRef
19.
Zurück zum Zitat Batacchi S, Matano S, Nella A, Zagli G, Bonizzoli M, Pasquini A, et al. Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. Crit Care. 2009;13(6):R194.CrossRef Batacchi S, Matano S, Nella A, Zagli G, Bonizzoli M, Pasquini A, et al. Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. Crit Care. 2009;13(6):R194.CrossRef
20.
Zurück zum Zitat Ball CG, Dente CJ, Shaz B, Wyrzykowski AD, Nicholas JM, Kirkpatrick AW, et al. The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: does it increase abdominal wall closure rates? Can J Surg. 2013;56(5):E128–34.CrossRef Ball CG, Dente CJ, Shaz B, Wyrzykowski AD, Nicholas JM, Kirkpatrick AW, et al. The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: does it increase abdominal wall closure rates? Can J Surg. 2013;56(5):E128–34.CrossRef
21.
Zurück zum Zitat Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for acute kidney injury. Kidney Inter Suppl. 2012;2:1-138. Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for acute kidney injury. Kidney Inter Suppl. 2012;2:1-138.
22.
Zurück zum Zitat Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, et al. Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2013;74(1):113–20 (discussion 1120-2).CrossRef Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, et al. Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2013;74(1):113–20 (discussion 1120-2).CrossRef
23.
Zurück zum Zitat Goussous N, Jenkins DH, Zielinski MD. Primary fascial closure after damage control laparotomy: sepsis vs haemorrhage. Injury. 2014;45(1):151–5.CrossRef Goussous N, Jenkins DH, Zielinski MD. Primary fascial closure after damage control laparotomy: sepsis vs haemorrhage. Injury. 2014;45(1):151–5.CrossRef
24.
Zurück zum Zitat Ramsamy Y, Hardcastle TC, Muckart DJJ. Surviving sepsis in the intensive care unit: the challenge of antimicrobial resistance and the trauma patient. World J Surg. 2017;41(5):1165–9.CrossRef Ramsamy Y, Hardcastle TC, Muckart DJJ. Surviving sepsis in the intensive care unit: the challenge of antimicrobial resistance and the trauma patient. World J Surg. 2017;41(5):1165–9.CrossRef
25.
Zurück zum Zitat Vogel T, Diaz J, Miller R, May A, Guillamondegui O, Guy J, et al. The open abdomen in trauma: do infectious complications affect primary abdominal closure? Surg Infect. 2006;7:433–41.CrossRef Vogel T, Diaz J, Miller R, May A, Guillamondegui O, Guy J, et al. The open abdomen in trauma: do infectious complications affect primary abdominal closure? Surg Infect. 2006;7:433–41.CrossRef
26.
Zurück zum Zitat Scriba MF, Laing GL, Bruce JL, Sartorius B, Clarke DL. The role of planned and on-demand relaparotomy in the developing world. World J Surg. 2016;40(7):1558–64.CrossRef Scriba MF, Laing GL, Bruce JL, Sartorius B, Clarke DL. The role of planned and on-demand relaparotomy in the developing world. World J Surg. 2016;40(7):1558–64.CrossRef
27.
Zurück zum Zitat Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, et al. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001;182(6):542–6.CrossRef Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, et al. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001;182(6):542–6.CrossRef
28.
Zurück zum Zitat Hendrickson S, Chacko L, Wilson M. Raised intracranial pressure following abdominal closure in a polytrauma patient. JRSM Open. 2015;6:2054270414565958.CrossRef Hendrickson S, Chacko L, Wilson M. Raised intracranial pressure following abdominal closure in a polytrauma patient. JRSM Open. 2015;6:2054270414565958.CrossRef
Metadaten
Titel
Open abdomen in the trauma ICU patient: who? when? why? and what are the outcome results?
verfasst von
Kurt Nirishan Boolaky
Ali Hassan Tariq
Timothy Craig Hardcastle
Publikationsdatum
17.11.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 2/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01543-6

Weitere Artikel der Ausgabe 2/2022

European Journal of Trauma and Emergency Surgery 2/2022 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.