Treatment of Severe Intra-abdominal Sepsis and/or Necrotic Foci by an 'Open-Abdomen' Approach

García-Sabrido, J.L.; Tallado, J. M.; Christou, Nicolas V.; Polo, James; Valdecantos, E.

doi:10.1001/archsurg.1988.01400260032002

Cited by 109 publications

(63 citation statements)

References 19 publications

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“…Once adequate source control is obtained, appropriate antimicrobial therapy improves outcomes (71,172,175,251). Mortality secondary to intra-abdominal sepsis has been approximated at 25 to 35% but can exceed 70% (16,17,75,83).…”

Section: Intra-abdominal Infectionsmentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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SUMMARY Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa , those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.

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Section: Intra-abdominal Infectionsmentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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“…After the literature review, 12 articles were selected 16,[18][19][20][21][22][23][24][25][26][27][28] (Table 2).…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…Van Goor et al 10 defined the indication for zip closure as diffuse suppurative peritonitis caused by colonic perforation or anastomotic dehiscence in which the abdominal cavity remains grossly contaminated after the initial laparotomy. Garcia-Sabrido et al 19 recommend zipper laparotomy when there is uncertain control or incomplete drainage of septic foci, when a compromised anastomosis must be observed, or when bowel viability is uncertain in cases of mesenteric ischemia. According to Walsh et al 20 , it is likely that the approach was used too early in some patients and too late in others.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

Utiyama

Pflug

Damous

et al. 2015

Rev. Col. Bras. Cir.

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OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

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“…187 The negative pressure vacuum-VAC closure device (KCI International, San Antonio TX) has had considerable recent success as a first-up method of open wound management 188 with selected alternatives including temporary absorbable and non-absorbable forms of mesh, 189,190 silos 191 and 'zipper-style' techniques. [192][193][194] The sandwich suction dressing is the easiest and cheapest method to employ being a forerunner of the VAC technique with placement of large adhesive drapes into the paracolic gutter under suction drains. 195 This simple dressing is effective, containing the abdominal contents with minimal fluid leakage and is non-contributory either to worsening IAP or the early development of adhesions.…”

Section: Surgical Decompressionmentioning

confidence: 99%

“…[192][193][194] The sandwich suction dressing is the easiest and cheapest method to employ being a forerunner of the VAC technique with placement of large adhesive drapes into the paracolic gutter under suction drains. 195 This simple dressing is effective, containing the abdominal contents with minimal fluid leakage and is non-contributory either to worsening IAP or the early development of adhesions.…”

mentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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Treatment of Severe Intra-abdominal Sepsis and/or Necrotic Foci by an 'Open-Abdomen' Approach

Cited by 109 publications

References 19 publications

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

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