Managing The Open Abdomen

Haldipur, Nandan; Cooper, B J; Sanyal, Sumit

doi:10.1136/jramc-152-03-06

Cited by 6 publications

(8 citation statements)

References 30 publications

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“…Plaudis et al described abdominal negative-pressure therapy in their prospective study with 25 surgical patients as a new method in countering ACS and peritonitis 90 . However, management of the open abdomen is still associated with a number of complications including persistent sepsis and development of multiple organ dysfunction [91][92][93] . The second step is control of fluid balance for maintenance of adequate organ perfusion and also to control the third space.…”

Section: Intraabdominal Hypertension and Abdominal Compartment Syndromentioning

confidence: 99%

Acute kidney injury following acute pancreatitis: A review

Petejová¹,

Martínek²

2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Backround. Acute kidney injury (AKI) is a common serious complication of severe acute pancreatitis (SAP) and an important marker of morbidity and mortality in critically ill septic patients. AKI due to severe acute pancreatitis can be the result of hypoxemia, release of pancreatic amylase from the injured pancreas with impairment of renal microcirculation, decrease in renal perfusion pressure due to abdominal compartment syndrome, intraabdominal hypertension or hypovolemia. Endotoxins and reactive oxygen species (ROS) also play an important role in the pathophysiology of SAP and AKI. Knowledge of the pathophysiology and diagnosis of AKI following SAP might improve the therapeutic outcome of critically ill patients. Methods and Results. An overview of the pathophysiology, diagnosis and potential treatment options based on a literature search of clinical human and experimental studies from 1987 to 2013. Conclusions. Early recognition of AKI and SAP in order to prevent severe complication like septic shock, intraabdominal hypertension or abdominal compartment syndrome leading to multiple organ dysfunction syndrome is a crucial tool of therapeutic measures in intensive care.

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Section: Intraabdominal Hypertension and Abdominal Compartment Syndromentioning

confidence: 99%

Acute kidney injury following acute pancreatitis: A review

Petejová¹,

Martínek²

2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Compared to other techniques, NPT systems are intended to provide active abdominal therapy by controlling the abdominal contents and actively removing exudate from all the abdominal compartments [4,18,21,23]. The level of vacuum can be altered individually, although the best results have been demonstrated with a pressure of 125 mmHg [2,10]. The recommended interval between dressing changes is usually 24 to 72 h; however, the actual timing of dressing changes may vary individually depending on the patient's clinical status and indications [1,2,10,24].…”

Section: Discussionmentioning

confidence: 99%

“…The level of vacuum can be altered individually, although the best results have been demonstrated with a pressure of 125 mmHg [2,10]. The recommended interval between dressing changes is usually 24 to 72 h; however, the actual timing of dressing changes may vary individually depending on the patient's clinical status and indications [1,2,10,24]. …”

Section: Discussionmentioning

confidence: 99%

“…Abdominal negative-pressure therapy (NPT) has opened new opportunities in the treatment of patients with intra-abdominal hypertension (IAH), complicated intra-abdominal infection (IAI) and severely polytraumatised patients in whom damage control laparotomy is mandatory [1]. During the latest decades, a number of techniques have been described on the management of patients with OA including the Bogota bag, towel clamp and zipper technique; however, results of the treatment have not been satisfactory [2]. Implementation of the Wittmann patch and home-made NPT systems gave stimulus to the development of commercially available systems that are at present considered to be the most effective [3].…”

Section: Introductionmentioning

confidence: 99%

“…Implementation of the Wittmann patch and home-made NPT systems gave stimulus to the development of commercially available systems that are at present considered to be the most effective [3]. Nevertheless, clinical experience in the application of different abdominal NPT techniques is scarce and lacks definitive opinion about the indications and timing of NPT [1,2]. This method is still associated with high morbidity and high incidence of ventral hernia formation in surviving patients caused by difficulties in definitive closure of the abdominal wall after prolonged application of NPT [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

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Abdominal negative-pressure therapy: a new method in countering abdominal compartment and peritonitis - prospective study and critical review of literature

Plaudis

Rudzāts

Melberga

et al. 2012

Annals of Intensive Care

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BackgroundApplication of abdominal negative-pressure therapy (NPT) is lifesaving when conservative measures fail to reduce sustained increase of the intra-abdominal pressure and it is impossible to achieve source control in a single operation due to severe peritonitis. The aim of this study is to share the initial experience with abdominal NPT in Latvia and provide a review of the relevant literature.MethodsIn total, 22 patients were included. All patients were treated with KCI® ABThera™ NPT systems. Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission, daily sequential organ failure assessment score and Mannheim peritonitis index (MPI) were calculated for severity definition. The frequency of NPT system changes, daily amount of aspirated fluid effluent and the time of abdominal closure were assessed. The overall hospital and ICU stay, as well as the outcomes and the complication rate, were analysed.ResultsA complicated intra-abdominal infection was treated in 18 patients. Abdominal compartment syndrome due to severe acute pancreatitis (SAP), secondary ileus and damage control in polytrauma were indications for NPT in four patients. The median age of the patients was 59 years (range, 28 to 81), median APACHE II score was 15 points (range, 9 to 32) and median MPI was 28 points (range, 21 to 40), indicating a prognostic mortality risk of 60%. Sepsis developed in all patients, and in 20 of them, it was severe. NPT systems were changed on a median of every 4 days, and abdominal closure was feasible on the seventh postoperative day without needing a repeated laparotomy. Two NPT systems were removed due to bleeding from the retroperitoneal space in patients with SAP. Intestinal fistulae developed in three patients that were successfully treated conservatively. Incisional hernia occurred in three patients. The overall ICU and hospital stay were 14 (range, 5 to 56) and 25 days (range, 10 to 87), respectively. Only one patient died, contributing to the overall mortality of 4.5%.ConclusionsApplication of abdominal NPT could be a very promising technique for the control of sustained intra-abdominal hypertension and management of severe sepsis due to purulent peritonitis. Further trials are justified for a detailed evaluation of abdominal NPT indications.

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Open Abdomen

Ipponi¹

2018

The Art of Hernia Surgery

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Managing The Open Abdomen

Cited by 6 publications

References 30 publications

Acute kidney injury following acute pancreatitis: A review

Acute kidney injury following acute pancreatitis: A review

Abdominal negative-pressure therapy: a new method in countering abdominal compartment and peritonitis - prospective study and critical review of literature

Open Abdomen

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