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Open Access 01-12-2009 | Research

Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures

Authors: Stefano Batacchi, Stefania Matano, Alessandra Nella, Giovanni Zagli, Manuela Bonizzoli, Andrea Pasquini, Valentina Anichini, Valentina Tucci, Giuseppe Manca, Kevin Ban, Andrea Valeri, Adriano Peris

Published in: Critical Care | Issue 6/2009

Abstract

Introduction

Critically ill surgical patients frequently develop intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) with subsequent high mortality. We compared two temporary abdominal closure systems (Bogota bag and vacuum-assisted closure (VAC) device) in intra-abdominal pressure (IAP) control.

Methods

This prospective study with a historical control included 66 patients admitted to a medical and surgical intensive care unit (ICU) of a tertiary care referral center (Careggi Hospital, Florence, Italy) from January 2006 to April 2009. The control group included patients consecutively treated with the Bogota bag (Jan 2006-Oct 2007), whereas the prospective group was comprised of patients treated with a VAC. All patients underwent abdominal decompressive surgery. Groups were compared based upon their IAP, SOFA score, serial arterial lactates, the duration of having their abdomen open, the need for mechanical ventilation (MV) along with length of ICU and hospital stay and mortality. Data were collected from the time of abdominal decompression until the end of pressure monitoring.

Results

The Bogota and VAC groups were similar with regards to demography, admission diagnosis, severity of illness, and IAH grading. The VAC system was more effective in controlling IAP (P < 0.01) and normalizing serum lactates (P < 0.001) as compared to the Bogota bag during the first 24 hours after surgical decompression. There was no significant difference between the SOFA scores. When compared to the Bogota, the VAC group had a faster abdominal closure time (4.4 vs 6.6 days, P = 0.025), shorter duration of MV (7.1 vs 9.9 days, P = 0.039), decreased ICU length of stay (LOS) (13.3 vs 19.2 days, P = 0.024) and hospital LOS (28.5 vs 34.9 days; P = 0.019). Mortality rate did not differ significantly between the two groups.

Conclusions

Patients with abdominal compartment syndrome who were treated with VAC decompression had a faster abdominal closure rate and earlier discharge from the ICU as compared to similar patients treated with the Bogota bag.

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Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006, 32: 1722-1732. 10.1007/s00134-006-0349-5CrossRefPubMed

Malbrain ML, Vidts W, Ravyts M, De Laet I, De Waele J: Acute intestinal distress syndrome: the importance of intra-abdominal pressure. Minerva Anestesiol 2008, 74: 657-673.PubMed

Malbrain ML: Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care 2004, 10: 132-145. 10.1097/00075198-200404000-00010CrossRefPubMed

Kotzampassi K, Paramythiotis D, Eleftheriadis E: Deterioration of visceral perfusion caused by intra-abdominal hypertension in pigs ventilated with positive end-expiratory pressure. Surg Today 2000, 30: 987-992. 10.1007/s005950070018CrossRefPubMed

Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Cox CS, Moore FA: Patients with impending abdominal compartment syndrome do not respond to early volume loading. Am J Surg 2003, 186: 602-607. discussion 607-608 10.1016/j.amjsurg.2003.09.002CrossRefPubMed

Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K: Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 1999, 134: 1082-1085. 10.1001/archsurg.134.10.1082CrossRefPubMed

Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA, Valdivia A, Ware DN, Moore FA: Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 2003, 54: 848-859. discussion 859-861 10.1097/01.TA.0000070166.29649.F3CrossRefPubMed

De Keulenaer BL, De Waele JJ, Powell B, Malbrain ML: What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med 2009, 35: 969-976. 10.1007/s00134-009-1445-0CrossRefPubMed

Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 2007, 33: 951-962. 10.1007/s00134-007-0592-4CrossRefPubMed

10.

Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM: Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997, 174: 667-672. discussion 672-663 10.1016/S0002-9610(97)00201-8CrossRefPubMed

11.

Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L: Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004, 30: 822-829. 10.1007/s00134-004-2169-9CrossRefPubMed

12.

Malbrain ML, De Laet IE, De Waele JJ: IAH/ACS: The Rationale for Surveillance. World J Surg 2009, 33: 1110-1115. 10.1007/s00268-009-0039-xCrossRefPubMed

13.

Myers JA, Latenser BA: Nonoperative progressive "Bogota bag" closure after abdominal decompression. Am Surg 2002, 68: 1029-1030.PubMed

14.

Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG: Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2002, 89: 591-596. 10.1046/j.1365-2168.2002.02072.xCrossRefPubMed

15.

Aspesi M, Gamberoni C, Severgnini P, Colombo G, Chiumello D, Minoja G, Tulli G, Malacrida R, Pelosi P, Chiaranda M: The abdominal compartment syndrome. Clinical relevance. Minerva Anestesiol 2002, 68: 138-146.PubMed

16.

Sugrue M: Abdominal compartment syndrome. Curr Opin Crit Care 2005, 11: 333-338. 10.1097/01.ccx.0000170505.53657.48CrossRefPubMed

17.

Malbrain ML: You don't have any excuse, just start measuring abdominal pressure and act upon it! Minerva Anestesiol 2008, 74: 1-2.PubMed

18.

Biancofiore G, Bindi ML: Measurement and knowledge of intra-abdominal pressure in Italian intensive care units. Minerva Anestesiol 2008, 74: 5-8. quiz 9PubMed

19.

Cheatham ML: Abdominal compartment syndrome: pathophysiology and definitions. Scand J Trauma Resusc Emerg Med 2009, 17: 10. 10.1186/1757-7241-17-10PubMedCentralCrossRefPubMed

20.

Stone PA, Hass SM, Flaherty SK, DeLuca JA, Lucente FC, Kusminsky RE: Vacuum-assisted fascial closure for patients with abdominal trauma. J Trauma 2004, 57: 1082-1086. 10.1097/01.TA.0000149248.02598.9ECrossRefPubMed

21.

Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Carel Goslings J: Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg 2009, 33: 199-207. 10.1007/s00268-008-9867-3PubMedCentralCrossRefPubMed

22.

MacLean AA, O'Keeffe T, Augenstein J: Management strategies for the open abdomen: survey of the American Association for the Surgery of Trauma membership. Acta Chir Belg 2008, 108: 212-218.PubMed

23.

Gargiulo NJ, Simon RJ, Leon W, Machiedo GW: Hemorrhage exacerbates bacterial translocation at low levels of intra-abdominal pressure. Arch Surg 1998, 133: 1351-1355. 10.1001/archsurg.133.12.1351CrossRefPubMed

24.

Friedlander MH, Simon RJ, Ivatury R, DiRaimo R, Machiedo GW: Effect of hemorrhage on superior mesenteric artery flow during increased intra-abdominal pressures. J Trauma 1998, 45: 433-489. 10.1097/00005373-199809000-00002CrossRefPubMed

25.

Bradley SE, Bradley GP: The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest 1947, 26: 1010-1022. 10.1172/JCI101867PubMedCentralCrossRefPubMed

26.

Richards WO, Scovill W, Shin B, Reed W: Acute renal failure associated with increased intra-abdominal pressure. Ann Surg 1983, 197: 183-187.PubMedCentralCrossRefPubMed

27.

De Waele JJ, Hoste EA, Malbrain ML: Decompressive laparotomy for abdominal compartment syndrome--a critical analysis. Crit Care 2006, 10: R51. 10.1186/cc4870PubMedCentralCrossRefPubMed

Title: Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures
Authors: Stefano Batacchi
Stefania Matano
Alessandra Nella
Giovanni Zagli
Manuela Bonizzoli
Andrea Pasquini
Valentina Anichini
Valentina Tucci
Giuseppe Manca
Kevin Ban
Andrea Valeri
Adriano Peris
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Critical Care / Issue 6/2009
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc8193

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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