The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome

Joseph, Bellal; Zangbar, Bardiya; Pandit, Viraj; Vercruysse, Gary; Aziz, Hassan; Kulvatunyou, Narong; Wynne, Julie; OʼKeeffe, Terence; Tang, Andrew; Friese, Randall S.; Rhee, Peter

doi:10.1097/ta.0b013e3182a9ea44

Cited by 48 publications

(18 citation statements)

References 23 publications

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“…Significant improvements compared to large volume crystalloid resuscitation were observed, namely decreased overall transfusion volumes, lower rates of clinically significant coagulopathy, less bowel edema, and more frequent fascial closure at the first take back. 7,8,9,10,11 Although the rate of DCL was expected to decrease with the implementation of damage control resuscitation, the yearly rate of DCL at our institution after January 2009 actually increased.…”

Section: Introductionmentioning

confidence: 94%

Decreasing the Use of Damage Control Laparotomy in Trauma: A Quality Improvement Project

Harvin

Kao

Liang

et al. 2017

Journal of the American College of Surgeons

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Background Our institution has published damage control laparotomy (DCL) rates of 30% and documented the substantial morbidity associated with the open abdomen. The purpose of this quality improvement (QI) project was to decrease the rate of DCL at a busy, Level 1 trauma center in the United States. Study Design A prospective cohort of all emergent trauma laparotomies from 11/2013–10/2015 (QI group) were followed. The QI intervention was multi-faceted and included audit and feedback for every DCL case. Morbidity and mortality of the QI patients were compared to a published control (control group – emergent laparotomy from 01/2011–10/2013). Results A significant decrease was observed immediately upon beginning the QI project, from a 39% DCL rate in the control period to 23% in the QI group (p<0.001). This decrease was sustained over the two year study period. There were no differences in demographics, Injury Severity Score, or transfusions between the groups. No differences organ/space infection (control 16% vs QI 12%, p=0.15), fascial dehiscence (6% vs 8%, p=0.20), unplanned re-laparotomy (11% vs 10%, p=0.58), or mortality (9% vs 10%, p=0.69) was observed. The reduction in utilization resulted in a decrease of 68 DCLs over the two year period. There was a further reduction in the rate of DCL to 17% following completion of the QI project. Conclusion A QI initiative rapidly changed the utilization of DCL and improved quality of care by decreasing resource utilization without an increase morbidity or mortality. This decrease was sustained during the QI period and further improved upon following its completion.

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Section: Introductionmentioning

confidence: 94%

Decreasing the Use of Damage Control Laparotomy in Trauma: A Quality Improvement Project

Harvin

Kao

Liang

et al. 2017

Journal of the American College of Surgeons

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“…Much of what we know about plasma-based resuscitation comes from studies performed in the setting of trauma and hemorrhagic shock. Adoption of damage control resuscitation principles, especially using plasma as the primary volume expander instead of crystalloid or colloid, has been associated with decreased mortality (80,81), decreased edema-mediated complications such as abdominal compartment syndrome (82), and decreased incidence of inflammatory-mediated complications (83,84) such as acute respiratory distress syndrome, venous thromboembolism, and multiple organ failure.…”

Section: Colloidsmentioning

confidence: 99%

Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock

Chang

Holcomb

2016

Shock

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Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one which restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified. There is increasing evidence that normal saline is associated with increased mortality and kidney injury; balanced crystalloids may be a safer alternative. Albumin is similar to crystalloids in terms of outcomes in the septic population but is costlier. Hydroxyethyl starches appear to increase mortality and kidney injury in the critically ill and are no longer indicated in these patients. In the trauma population, the shift to plasma-based resuscitation with decreased use of crystalloid and colloid in the treatment of hemorrhagic shock has led to decreased inflammatory and edema-mediated complications. Studies are needed to determine if these benefits also occur with a similar resuscitation strategy in the setting of sepsis.

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“…Recent studies have investigated the morbidity associated with aggressive fluid resuscitation following DCL including the development of abdominal compartment syndrome and anastomotic leaks following colon resection [17,18]. One group found the amount of crystalloid infused in the first 24 h to be an independent risk factor for failure of primary facial closure [19].…”

Section: Crystalloidsmentioning

confidence: 99%

Volume Management and Resuscitation in Trauma

Bradley

Nelson

2014

Curr Anesthesiol Rep

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Trauma remains an enormous burden on the American medical system. While patients of all ages sustain severe trauma, it remains the most common cause of death in young adults. Exsanguination from uncontrolled hemorrhage is the leading cause of preventable death among the traumatically injured. The lethal triad of trauma is a culmination of coagulopathy, acidosis, and hypothermia that can rapidly deteriorate and lead to a patient's demise if not treated accordingly. The goal of trauma resuscitation is to prevent or halt this triad while minimizing iatrogenic injury. The provider has many options available in his armamentarium for resuscitation, but each carries its own risks and benefits. Over the past two decades, trauma research has given us a better understanding of and improved management strategies for this triad. This chapter will explore the various resuscitative options available and summarize the most recent literature regarding their use.

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The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome

Abstract: Epidemiologic/therapeutic study, level IV.

Cited by 48 publications

References 23 publications

Decreasing the Use of Damage Control Laparotomy in Trauma: A Quality Improvement Project

Decreasing the Use of Damage Control Laparotomy in Trauma: A Quality Improvement Project

Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock

Volume Management and Resuscitation in Trauma

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