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      • Record: found
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      Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management

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          Abstract

          The term “open abdomen” refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic repercussions that must be recognized and managed during postoperative care. This review article describes these issues and provides guidelines for the critical care physician managing a patient with an open abdomen.

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          The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital.

          Matthew Borgman, Philip Spinella, Jeremy Perkins … (2007)
          Patients with severe traumatic injuries often present with coagulopathy and require massive transfusion. The risk of death from hemorrhagic shock increases in this population. To treat the coagulopathy of trauma, some have suggested early, aggressive correction using a 1:1 ratio of plasma to red blood cell (RBC) units. We performed a retrospective chart review of 246 patients at a US Army combat support hospital, each of who received a massive transfusion (>/=10 units of RBCs in 24 hours). Three groups of patients were constructed according to the plasma to RBC ratio transfused during massive transfusion. Mortality rates and the cause of death were compared among groups. For the low ratio group the plasma to RBC median ratio was 1:8 (interquartile range, 0:12-1:5), for the medium ratio group, 1:2.5 (interquartile range, 1:3.0-1:2.3), and for the high ratio group, 1:1.4 (interquartile range, 1:1.7-1:1.2) (p < 0.001). Median Injury Severity Score (ISS) was 18 for all groups (interquartile range, 14-25). For low, medium, and high plasma to RBC ratios, overall mortality rates were 65%, 34%, and 19%, (p < 0.001); and hemorrhage mortality rates were 92.5%, 78%, and 37%, respectively, (p < 0.001). Upon logistic regression, plasma to RBC ratio was independently associated with survival (odds ratio 8.6, 95% confidence interval 2.1-35.2). In patients with combat-related trauma requiring massive transfusion, a high 1:1.4 plasma to RBC ratio is independently associated with improved survival to hospital discharge, primarily by decreasing death from hemorrhage. For practical purposes, massive transfusion protocols should utilize a 1:1 ratio of plasma to RBCs for all patients who are hypocoagulable with traumatic injuries.
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            Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations.

            Michael Cheatham, Manu Malbrain, Andrew Kirkpatrick … (2007)
            Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.
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              Lactate clearance and survival following injury.

              Jessica Hitchcock, Leah Greenspan, David Abramson … (1993)
              Previous reports cite optimization of O2 delivery (DO2) to 660 mL/min/m2, O2 consumption (VO2) to 170 mL/min/m2, and cardiac index (CI) of 4.5 L/min as predicting survival. We prospectively evaluated 76 consecutive patients with multiple trauma admitted directly to the ICU from the operating room or emergency department. Patients had serum lactate levels and oxygen transport measured on ICU admission and at 8, 16, 24, 36, and 48 hours. Patients were analyzed with respect to survival (S) versus nonsurvival (NS), lactate clearance to normal (< or = 2 mmol/L) by 24 and 48 hours, hemodynamic optimization as defined above, as well as Injury Severity Score (ISS), ICU stay (LOS), and admission blood pressure. All patients achieved non-flow-dependent VO2. There was no difference in CI, DO2, VO2, or ISS when S was compared with NS. All 27 patients whose lactate level normalized in 24 hours survived. If lactate levels cleared to normal between 24 and 48 hours, the survival rate was 75%. Only 3 of the 22 patients who did not clear their lactate level to normal by 48 hours survived. Ten of the 25 nonsurvivors (40%) achieved the above arbitrary optimization criteria. Fifteen of the survivors never achieved any of these criteria. Optimization alone does not predict survival. However, the time needed to normalize serum lactate levels is an important prognostic factor for survival in severely injured patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Trauma Surg Acute Care Open
                Journal ID (iso-abbrev): Trauma Surg Acute Care Open
                Journal ID (hwp): tsaco
                Journal ID (publisher-id): tsaco
                Title: Trauma Surgery & Acute Care Open
                Publisher: Trauma Surgery & Acute Care Open (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2397-5776
                Publication date Collection: 2017
                Publication date (Electronic): 3 September 2017
                Volume: 2
                Issue: 1
                Electronic Location Identifier: e000063
                Affiliations
                [1 ]departmentSchool of Medicine , University of Utah , Salt Lake City, Utah, USA
                [2 ]departmentDepartment of Surgery , University of Utah , Salt Lake City, Utah, USA
                Author notes
                [Correspondence to ] Dr Ram Nirula, Department of Surgery, University of Utah, Salt Lake City, UT 84108, USA; r.nirula@ 123456hsc.utah.edu
                Article
                Publisher ID: tsaco-2016-000063
                DOI: 10.1136/tsaco-2016-000063
                PMC ID: 5877893
                PubMed ID: 29766080
                SO-VID: 0888e1bf-a410-4cc2-acb0-1395ff4d3685
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 03 January 2017
                Date revision received : 15 April 2017
                Date accepted : 16 May 2017
                Categories
                Subject: Review
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: abdominal compartment syndrome,open abdomen management,ventilator,early closure
                Data availability:
                Keywords: abdominal compartment syndrome, open abdomen management, ventilator, early closure

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