BACKGROUND Open abdomen (OA) and temporary abdominal closure (TAC) are common techniques to manage several surgical problems in trauma and emergency general surgery (EGS). Patients with an OA are subjected to prolonged mechanical ventilation. This can lead to increased rates of ventilator-associated pneumonia (VAP). We hypothesized that patients who were extubated with an OA would have a decrease in ventilator hours and as a result would have a lower rate of VAP without an increase in extubation failures. METHODS A retrospective review was performed of all trauma and EGS patients managed at our institution with OA and TAC from January 2014 to February 2016. Patients were divided into cohorts consisting of those who were successfully extubated with an OA and those who were not. The number of extubation events and ventilator-free hours were calculated for each patient. Adverse events such as the need for reintubation with an OA and VAP were collected. RESULTS Fifty-two patients (20 trauma, 32 EGS) were managed with an OA and TAC during the study period. Twenty-five patients (6 trauma, 19 EGS) had at least one extubation event with an OA. Median extubation events per patient was 3 (interquartile range, 1–5). The median ventilator-free hours for patients who were extubated was 101 hours (interquartile range, 39.42–260.46). Patients that were never extubated with an OA had higher rates of VAP (30.8% vs. 3.8%, p = 0.01). CONCLUSION This study provides much needed data regarding the feasibility of extubation in trauma and EGS patients managed with an OA and TAC. Benefits of early extubation may include lower VAP rates in this population. Plans for reexploration hinder the decision to extubate in these patients. LEVEL OF EVIDENCE Therapeutic study, level IV.

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There was considerable overlap of all other terms across multiple SOIs. Conclusions: With few exceptions, the language that ICU clinicians commonly use to describe patients poorly differentiates them according to SOI. Consequently, care teams risk misunderstanding what is meant when these terms are used and leading to possible medical errors.Learning Objectives: The Surgical/Trauma ICU/PCU (STICU) multidisciplinary team has worked to reduce sedation and delirium in all our patients by utilizing an evidence-based resource: ABCDE bundle (Awakening and Breathing Trial Coordination, Delirium Assessment and Management, Early Exercise/Progressive Mobility). This quality project focused on the "E" component of the bundle. Progressively mobilizing ICU patients, even in the early phases of illness, prevents ICU acquired weakness and decreases delirium, ventilator-associated pneumonia, and length of stay. Baseline audits revealed limited use of our standard adult ICU early mobility algorithm and delays in moving patients along the mobility continuum. Methods: Our team tailored our standard mobility algorithm to the STICU population. Safety screening criteria were used to determine patient readiness for mobility and the Richmond Agitation/Sedation Score guided specific interventions. The patient's actual mobility levels were tracked with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM). Multidisciplinary staff education was instituted using staff meetings, 1-1 conversations, and flyers. "Move" signs on the STICU walls every 20 feet served as visual reinforcement. Results: Fewer patients (5.6% to 4.9%) were moved to lateral transfer chairs (JH-HLM Level 2). There was a modest increase of total STICU patient (27% to 30%), who were dangled, stood or pivoted to a chair (JH-HLM Levels 3-5) although the largest increase was noted in the PCU population (18.8% to 28.5%). While the cumulative percentage of STICU patients walking any distance pre to post-intervention was similar, there was an increase in the distances walked (JH-HLM Levels 6-8) in both ICU and PCU patients (>250 feet) ICU: 3.4% to 37.2%, PCU: 18.8% to 34.8%. Conclusions: Our multidisciplinary team successfully shifted unit culture regarding the approach to mobility, and modified our standard ICU mobility algorithm to meet the unique needs of STICU patients. Incorporating early mobility takes teamwork, ongoing communication, persistence, and accountability to address mobility needs of every patient.

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