Vacuum-assisted Closure Device Enhances Recovery of Critically Ill Patients Following Emergency Surgical Procedures

Overview

Journal Crit Care

Specialty Critical Care

Date 2009 Dec 8

PMID 19961614

Citations 29

Authors

Stefano Batacchi

Stefania Matano

Alessandra Nella

Giovanni Zagli

Manuela Bonizzoli

Andrea Pasquini

Valentina Anichini

Valentina Tucci

Giuseppe Manca

Kevin Ban

Andrea Valeri

Adriano Peris

Affiliations

Soon will be listed here.

Abstract

Introduction: Critically ill surgical patients frequently develop intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) with subsequent high mortality. We compared two temporary abdominal closure systems (Bogota bag and vacuum-assisted closure (VAC) device) in intra-abdominal pressure (IAP) control.

Methods: This prospective study with a historical control included 66 patients admitted to a medical and surgical intensive care unit (ICU) of a tertiary care referral center (Careggi Hospital, Florence, Italy) from January 2006 to April 2009. The control group included patients consecutively treated with the Bogota bag (Jan 2006-Oct 2007), whereas the prospective group was comprised of patients treated with a VAC. All patients underwent abdominal decompressive surgery. Groups were compared based upon their IAP, SOFA score, serial arterial lactates, the duration of having their abdomen open, the need for mechanical ventilation (MV) along with length of ICU and hospital stay and mortality. Data were collected from the time of abdominal decompression until the end of pressure monitoring.

Results: The Bogota and VAC groups were similar with regards to demography, admission diagnosis, severity of illness, and IAH grading. The VAC system was more effective in controlling IAP (P < 0.01) and normalizing serum lactates (P < 0.001) as compared to the Bogota bag during the first 24 hours after surgical decompression. There was no significant difference between the SOFA scores. When compared to the Bogota, the VAC group had a faster abdominal closure time (4.4 vs 6.6 days, P = 0.025), shorter duration of MV (7.1 vs 9.9 days, P = 0.039), decreased ICU length of stay (LOS) (13.3 vs 19.2 days, P = 0.024) and hospital LOS (28.5 vs 34.9 days; P = 0.019). Mortality rate did not differ significantly between the two groups.

Conclusions: Patients with abdominal compartment syndrome who were treated with VAC decompression had a faster abdominal closure rate and earlier discharge from the ICU as compared to similar patients treated with the Bogota bag.

Citing Articles

Abdominal and thoracic wall closure: damage control surgery's cinderella.

Rodriguez-Holguin F, Hadad A, Mejia D, Garcia A, Cevallos C, Himmler A Colomb Med (Cali). 2021; 52(2):e4144777.

PMID: 34908622 PMC: 8634273. DOI: 10.25100/cm.v52i2.4777.

Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters.

Willms A, Schwab R, von Websky M, Berrevoet F, Tartaglia D, Sorelius K Hernia. 2020; 26(1):61-73.

PMID: 33219419 PMC: 8881440. DOI: 10.1007/s10029-020-02336-x.

Successful Use of Negative Pressure Wound Therapy for Abdominal Wall Necrosis Caused by a Perforated Ascending Colon Using the ABThera System.

Imaoka K, Yano T, Choda Y, Oshita K, Tani Y, Kubota T Case Rep Surg. 2020; 2020:8833566.

PMID: 32774978 PMC: 7391113. DOI: 10.1155/2020/8833566.

An open and closed case: timing of closure following laparostomy.

Granger S, Fallon J, Hopkins J, Pullyblank A Ann R Coll Surg Engl. 2020; 102(7):519-524.

PMID: 32538103 PMC: 7450447. DOI: 10.1308/rcsann.2020.0105.

Entero-atmospheric fistula migration: a new management alternative for complex septic open abdomen.

Pereira B, Duchesne J, Concon-Filho A, Leppaniemi A Anaesthesiol Intensive Ther. 2020; 52(1):56-62.

PMID: 32024350 PMC: 10173142. DOI: 10.5114/ait.2020.92748.

References

Myers J, Latenser B . Nonoperative progressive "Bogota bag" closure after abdominal decompression. Am Surg. 2002; 68(11):1029-30. View

Malbrain M, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V . Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004; 30(5):822-9. DOI: 10.1007/s00134-004-2169-9. View

Sugrue M, Jones F, Deane S, Bishop G, Bauman A, Hillman K . Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg. 1999; 134(10):1082-5. DOI: 10.1001/archsurg.134.10.1082. View

Biancofiore G, Bindi M . Measurement and knowledge of intra-abdominal pressure in Italian Intensive Care Units. Minerva Anestesiol. 2008; 74(1-2):5-8. View

Malbrain M, Vidts W, Ravyts M, De Laet I, De Waele J . Acute intestinal distress syndrome: the importance of intra-abdominal pressure. Minerva Anestesiol. 2008; 74(11):657-73. View

Malbrain M . You don't have any excuse, just start measuring abdominal pressure and act upon it!. Minerva Anestesiol. 2008; 74(1-2):1-2. View

Malbrain M, De Laet I, De Waele J . IAH/ACS: the rationale for surveillance. World J Surg. 2009; 33(6):1110-5. DOI: 10.1007/s00268-009-0039-x. View

Cheatham M . Abdominal compartment syndrome: pathophysiology and definitions. Scand J Trauma Resusc Emerg Med. 2009; 17:10. PMC: 2654860. DOI: 10.1186/1757-7241-17-10. View

MacLean A, OKeeffe T, Augenstein J . Management strategies for the open abdomen: survey of the American Association for the Surgery of Trauma membership. Acta Chir Belg. 2008; 108(2):212-8. DOI: 10.1080/00015458.2008.11680206. View

10.

Malbrain M . Is it wise not to think about intraabdominal hypertension in the ICU?. Curr Opin Crit Care. 2004; 10(2):132-45. DOI: 10.1097/00075198-200404000-00010. View

11.

Balogh Z, McKinley B, Holcomb J, Miller C, Cocanour C, Kozar R . Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003; 54(5):848-59; discussion 859-61. DOI: 10.1097/01.TA.0000070166.29649.F3. View

12.

Malbrain M, Cheatham M, Kirkpatrick A, Sugrue M, Parr M, De Waele J . Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006; 32(11):1722-32. DOI: 10.1007/s00134-006-0349-5. View

13.

Friedlander M, Simon R, Ivatury R, DiRaimo R, Machiedo G . Effect of hemorrhage on superior mesenteric artery flow during increased intra-abdominal pressures. J Trauma. 1998; 45(3):433-89. DOI: 10.1097/00005373-199809000-00002. View

14.

Stone P, Hass S, Flaherty S, Deluca J, Lucente F, Kusminsky R . Vacuum-assisted fascial closure for patients with abdominal trauma. J Trauma. 2004; 57(5):1082-6. DOI: 10.1097/01.ta.0000149248.02598.9e. View

15.

De Keulenaer B, De Waele J, Powell B, Malbrain M . What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure?. Intensive Care Med. 2009; 35(6):969-76. DOI: 10.1007/s00134-009-1445-0. View

16.

Richards W, Scovill W, Shin B, Reed W . Acute renal failure associated with increased intra-abdominal pressure. Ann Surg. 1983; 197(2):183-7. PMC: 1353107. DOI: 10.1097/00000658-198302000-00010. View

17.

Meldrum D, Moore F, Moore E, Franciose R, Sauaia A, Burch J . Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997; 174(6):667-72; discussion 672-3. DOI: 10.1016/s0002-9610(97)00201-8. View

18.

Bradley S, BRADLEY G . THE EFFECT OF INCREASED INTRA-ABDOMINAL PRESSURE ON RENAL FUNCTION IN MAN. J Clin Invest. 1947; 26(5):1010-22. PMC: 439406. DOI: 10.1172/JCI101867. View

19.

Gargiulo 3rd N, Simon R, Leon W, Machiedo G . Hemorrhage exacerbates bacterial translocation at low levels of intra-abdominal pressure. Arch Surg. 1998; 133(12):1351-5. DOI: 10.1001/archsurg.133.12.1351. View

20.

Hong J, Cohn S, Perez J, Dolich M, Brown M, McKenney M . Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg. 2002; 89(5):591-6. DOI: 10.1046/j.1365-2168.2002.02072.x. View