Evaluating the effects of immediate application of negative pressure therapy after decompression from abdominal compartment syndrome in an experimental porcine model

Shah, Shinil K.; Jiménez, Fernando; Walker, Peter A.; Xue, Hasan; Feeley, Teri D.; Uray, Karen; Norbury, Kenneth C.; Stewart, Randolph H.; Laine, Glen A.; Cox, Charles S.

doi:10.1007/s00068-011-0136-z

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…The first surgical step was performed via midline laparotomy and consisted of peritoneal lavage and drainage, resection of perforated colon with stapled closure of proximal and caudal stumps, and temporary abdominal closure with NPWT-i. 19-21…”

Section: Methodsmentioning

confidence: 99%

Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease

Brillantino¹,

Andreano²,

Lanza³

et al. 2019

Surg Innov

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Purpose. To evaluate the results of Damage Control Strategy (DCS) in the treatment of generalized peritonitis from perforated diverticular disease in patients with preoperative severe systemic diseases. Methods. All the patients with diffuse peritonitis (Hinchey 3 and 4) and the American Society of Anesthesiologists (ASA) score ≥3 were included and underwent DCS consisting of a 2-step procedure. The first was peritoneal lavage, perforated colon-stapled resection, and temporary abdominal closure with negative pressure wound therapy combined with instillation. The second step, 48 hours later, included the possibility of restoring intestinal continuity basing on local and general patients’ conditions. Results. Thirty patients (18 [60%] women and 12 [40%] men, median age 68.5 [range = 35-84] years) were included (18 [60%] ASA III, 11 [36.7%] ASA IV, and 1 [0.03%] ASA V). Seven patients (23.3%) showed sepsis and 1 (3.33%) septic shock. At second surgery, 24 patients (80%) received a colorectal anastomosis and 6 patients (20%) underwent a Hartmann’s procedure. Median hospital stay was 18 days (range = 12-62). Postoperative morbidity rate was 23.3% (7/30) and included 1 anastomotic leak treated with Hartmann’s procedure. Consequently, at discharge from hospital, 23 patients (76.6%) were free of stoma. Primary fascial closure was possible in all patients. Conclusions. DCS with temporary abdominal closure by negative pressure wound therapy combined with instillation in patients with diffuse peritonitis from complicated diverticulitis could represent a feasible surgical option both in hemodynamically stable and no stable patients, showing encouraging results including a low stoma rate and an acceptable morbidity rate.

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Section: Methodsmentioning

confidence: 99%

Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease

Brillantino¹,

Andreano²,

Lanza³

et al. 2019

Surg Innov

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“…In support of this, a large number of animal studies have evaluated the efficacy of damage control surgery and specific damage control interventions (e.g., rapid bowel ligation without reanastomosis [ 31 , 41 ], intraluminal balloon occlusion of the aorta [ 33 , 42 ], and temporary intravascular shunting of the superior mesenteric artery [ 30 , 39 , 40 ]) or adjuncts (e.g., commercial topical hemostatic agents for massively bleeding groin injuries [ 37 , 43 ]). See Table 1 for a complete list of damage control interventions/adjuncts that are currently used in clinical practice, including a sample of those that have been evaluated in animal models [ 30 - 32 , 39 - 41 , 43 - 53 ]. These studies may collectively provide insight into which interventions have the most promise for further clinical evaluation and use [ 27 , 29 , 54 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of damage control in experimental animal models of injury: protocol for a systematic review and meta-analysis

2014

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BackgroundAlthough abbreviated surgery with planned reoperation (damage control surgery) is now widely used to manage major trauma patients, the procedure and its component interventions have not been evaluated in randomized controlled trials (RCTs). While some have suggested the need for such trials, they are unlikely to be conducted because of patient safety concerns. As animal studies may overcome several of the limitations of existing observational damage control studies, the primary objective of this study is to evaluate the efficacy and safety of damage control versus definitive surgery in experimental animal models of injury.Methods/designWe will search electronic databases (Medline, Embase, PubMed, Web of Science, Scopus, and the Cochrane Library), conference abstracts, personal files, and bibliographies of included articles. We will include RCTs and prospective cohort studies that utilized an animal model of injury and compared damage control surgery (or specific damage control interventions or adjuncts) to definitive surgery (or specific definitive surgical interventions). Two investigators will independently evaluate the internal and external/construct validity of individual studies. The primary outcome will be all-cause mortality. Secondary outcomes will include blood loss amounts; blood pressures and heart rates; urinary outputs; core body temperatures; arterial lactate, pH, and base deficit/excess values; prothrombin and partial thromboplastin times; international normalized ratios; and thromboelastography (TEG) results/activated clotting times. We will calculate summary relative risks (RRs) of mortality and mean differences (for continuous outcomes) using DerSimonian and Laird random effects models. Heterogeneity will be explored using subgroup meta-analysis and meta-regression. We will assess for publication bias using funnel plots and Begg’s and Egger’s tests. When evidence of publication bias exists, we will use the Duval and Tweedie trim and fill method to estimate the potential influence of this bias on pooled summary estimates.DiscussionThis study will evaluate the efficacy and safety of damage control in experimental animal models of injury. Study results will be used to guide future clinical evaluations of damage control surgery, determine which animal study outcomes may potentially be generalizable to the clinical setting, and to provide guidelines to strengthen the conduct and relevance of future pre-clinical studies.

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“…Given the small sample sizes, no conclusions could be made regarding survival. Negative pressure therapy was associated with reductions in central venous and mesenteric venous pressures which over time, may be associated with more favorable fluid flux profiles and augmented resolution of intestinal edema [ 66 , 107 , 108 ]. These data demonstrate that negative pressure therapy appears safe in the immediate post-decompression period from ACS and may be associated with improved outcomes/organ injury parameters.…”

Section: Introductionmentioning

confidence: 99%

Strategies for modulating the inflammatory response after decompression from abdominal compartment syndrome

Shah¹,

Jiménez²,

Letourneau³

et al. 2012

Scand J Trauma Resusc Emerg Med

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BackgroundManagement of the open abdomen is an increasingly common part of surgical practice. The purpose of this review is to examine the scientific background for the use of temporary abdominal closure (TAC) in the open abdomen as a way to modulate the local and systemic inflammatory response, with an emphasis on decompression after abdominal compartment syndrome (ACS).MethodsA review of the relevant English language literature was conducted. Priority was placed on articles published within the last 5 years.Results/ConclusionRecent data from our group and others have begun to lay the foundation for the concept of TAC as a method to modulate the local and/or systemic inflammatory response in patients with an open abdomen resulting from ACS.

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Evaluating the effects of immediate application of negative pressure therapy after decompression from abdominal compartment syndrome in an experimental porcine model

Cited by 3 publications

References 19 publications

Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease

Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease

Efficacy and safety of damage control in experimental animal models of injury: protocol for a systematic review and meta-analysis

Strategies for modulating the inflammatory response after decompression from abdominal compartment syndrome

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