Negative pressure wound therapy for managing the open abdomen in non-trauma patients

Cheng, Yao; Wang, Ke; Gong, Junhua; Liu, Zuojin; Gong, Jianping; Zeng, Zhong; Wang, Xiaomei

doi:10.1002/14651858.cd013710.pub2

Cited by 16 publications

(12 citation statements)

References 65 publications

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“…50 Yuksel Altinel reported no declarations. 51 Luz Adriana Hernandez Amin reported no declarations. 52 Jose Manuel Aranda reported no declarations.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis on the use of Damage Control in perforated acute colonic diverticulitis(48), found no RCTs and ultimately the conclusions reverted back to opinions, the weakest level of Evidence in the World Society of Emergency Surgery Consensus Guidelines (49,50). In 2022 Cheng published a Cochrane Review on the use of negative pressure wound therapy for the non-trauma open abdomen and concluded that no recommendations could be made as there was no meaningful data (51).…”

Section: Metanalyses and Randomized Controlled Studies Of The Open Ab...mentioning

confidence: 99%

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The Unrestricted Global effort to complete the Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (COOL) Trial

Kirkpatrick

Coccolini

Tolonen

et al. 2023

Preprint

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· Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL-trial)(https://clinicaltrials.gov/ct2/show/NCT03163095). Initially, the COOL-trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of patients allocated to the intervention (open) arm. In August 2022, the 3M/Acelity Corporation without consultation but within the terms of the contract cancelled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. · Methods: The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or use of the OA with application of an NPPT dressing. Patients are eligible if they have free uncontained intra-peritoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. · Discussion: OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of ‘damage control’, however improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL-trial trial seeks to expand potential sites and proceed with evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. · Trial registration: National Institutes of Health (https://clinicaltrials.gov/ct2/show/NCT03163095).

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“…50 Yuksel Altinel reported no declarations. 51 Luz Adriana Hernandez Amin reported no declarations. 52 Jose Manuel Aranda reported no declarations.…”

Section: Discussionmentioning

confidence: 99%

Section: Metanalyses and Randomized Controlled Studies Of The Open Ab...mentioning

confidence: 99%

The Unrestricted Global effort to complete the Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (COOL) Trial

Kirkpatrick

Coccolini

Tolonen

et al. 2023

Preprint

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“…Although initially used only for open wounds, it is now widely used in wound bed preparation to achieve wound closure with skin grafts or skin flaps owing to its granulation effect 15 . Recently, devices, such as the NPWT with instillation and dwell time (NPWTi‐d) 4 (which repeatedly injects cleaning solution, immerses the wound, and performs aspiration), the single‐use NPWT, 16,17 (which is highly portable and causes few skin problems), and the NPWT used for temporary closure of open abdomen, 18 have evolved significantly, owing to which, indications have expanded to include infected wounds and exposed organs, which had previously been considered unsafe 4 . The efficacy of NPWT in preventing wound infection, primarily in closed wounds, 19,20 has been described in a Cochrane review 20,21 …”

Section: Discussionmentioning

confidence: 99%

Novel cell culture system for monitoring cells during continuous and variable negative‐pressure wound therapy

Yamashiro

Kubota

Mayumi

et al. 2022

Skin Research and Technology

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Background Although the clinical efficacy of negative‐pressure wound therapy (NPWT) is well known, many of its molecular biological mechanisms remain unresolved, mainly due to the difficulty and paucity of relevant in vitro studies. We attempted to develop an in vitro cell culture system capable of real‐time monitoring of cells during NPWT treatment. Materials and methods A novel negative‐pressure cell culture system was developed by combining an inverted microscope, a stage‐top incubator, a sealed metal chamber for cell culture, and an NPWT treatment device. Human keratinocytes, PSVK‐1, were divided into ambient pressure (AP), continuous negative‐pressure (NPc), and intermittent negative‐pressure (NPi) groups and cultured for 24 h with scratch assay using our real‐time monitoring system and device. Pressure inside the device, medium evaporation rate, and the residual wound area were compared across the groups. Results Pressure in the device was maintained at almost the same value as set in all groups. Medium evaporation rate was significantly higher in the NPi group than in the other two groups; however, it had negligible effect on cell culture. Residual wound area after 9 h evaluated by the scratch assay was significantly smaller in the NPc and NPi groups than in the AP group. Conclusion We developed a negative‐pressure cell culture device that enables negative‐pressure cell culture under conditions similar to those used in clinical practice and is able to monitor cells under NPWT. Further experiments using this device would provide high‐quality molecular biological evidence for NPWT.

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“…W przypadku operacji odwrócenia stomii grupa badanych u których zastosowano NPWT wykazała lepsze gojenie się ran, mniejszy ból i większe zadowolenie z estetyki niż grupa u której stosowano inne metody opatrywania rany [10] . Z kolei w pierwotnym zamknięciu powięzi na otwartym brzuchu bez urazu, NPWT w porównaniu do innej metodyworka Bogota -nie okazała się być metodą bardziej innowacyjną [11]. Skuteczność NPWT potwierdza się także po zabiegach ortopedycznych, czy w terapii odleżyn lll i IV stopnia [12] [13].…”

Section: Npwt W Leczeniu Owrzodzeń Stopy Cukrzycowejunclassified

The effectiveness of negative pressure wound therapy compared to the traditional method in the treatment of diabetic foot

Bogucka

BRZYSKA²,

BOJARSKA³

et al. 2023

J Educ Health Sport

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Introduction and objective: Diabetes is one of the most common metabolic diseases in the world. Diabetic foot ulcers, which are often the result of the disease, are undoubtedly a nursing challenge. Negative pressure wound therapy (NPWT) is a new therapeutic method supporting wound healing, which has been useful in patients with diabetic foot. The purpose of this study is to compare the effectiveness of negative pressure therapy in comparison to the standard method in the treatment of diabetic foot. Review methods: In February 2023, articles found in the Medline (Pubmed) and Google Scholar databases were selected by using the following keywords: negative pressure wound therapy; VAC therapy; traditional dressing; standard moist wound care; diabetic foot. Brief description of the state of knowledge: NPWT has been proven to be associated with reduced healing time and faster appearance of granulation tissue, which is a sign of wound healing. Patients using this method require fewer dressing changes and surgical cleanings. Negative pressure therapy reduces the time to rehospitalisation and the risk of amputation or resection of the diabetic foot. Summary: Negative pressure wound therapy is more effective in the treatment of diabetic foot ulcers than traditional therapy. Despite the costs associated with NPWT being higher, the method proves to be more profitable. It is important to remember about good therapy technique and proper selection of patients.

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Negative pressure wound therapy for managing the open abdomen in non-trauma patients

Cited by 16 publications

References 65 publications

The Unrestricted Global effort to complete the Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (COOL) Trial

The Unrestricted Global effort to complete the Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (COOL) Trial

Novel cell culture system for monitoring cells during continuous and variable negative‐pressure wound therapy

The effectiveness of negative pressure wound therapy compared to the traditional method in the treatment of diabetic foot

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