Open abdominal management after damage-control laparotomy for trauma

DuBose, Joseph J.; Scalea, Thomas M.; Holcomb, John B.; Shrestha, Binod Bade; Okoye, Obi; Inaba, Kenji; Bee, Tiffany K.; Fabian, Timothy C.; Whelan, James; Ivatury, Rao R.

doi:10.1097/ta.0b013e31827891ce

Cited by 149 publications

(73 citation statements)

References 20 publications

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“…3,14,15,16,17,18 While the results of this study were not surprising, this analysis adds to the existing literature attempting to determine the treatment effect of DCL on post-operative morbidity by using novel methodology.…”

Section: Discussionmentioning

confidence: 81%

The effect of damage control laparotomy on major abdominal complications: A matched analysis

George

Adams

McNutt

et al. 2018

The American Journal of Surgery

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Section: Discussionmentioning

confidence: 81%

The effect of damage control laparotomy on major abdominal complications: A matched analysis

George

Adams

McNutt

et al. 2018

The American Journal of Surgery

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“…The PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) Study was conducted at ten level-1 trauma centers in the United States from July 2009 to October 2010 [16]. The primary objective of the PROMMTT study was to investigate in-hospital mortality to early transfusion of time-varying ratios of blood products.…”

Section: Methodsmentioning

confidence: 99%

Clinical gestalt and the prediction of massive transfusion after trauma

Pommerening¹,

Goodman²,

Holcomb³

et al. 2015

Injury

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105

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Introduction Early recognition and treatment of trauma patients requiring massive transfusion (MT) has been shown to reduce mortality. While many risk factors predicting MT have been demonstrated, there is no universally accepted method or algorithm to identify these patients. We hypothesized that even among experienced trauma surgeons, the clinical gestalt of identifying patients who will require MT is unreliable. Methods Transfusion and mortality outcomes after trauma were observed at 10 U.S. Level-1 trauma centers in patients who survived ≥30 minutes after admission and received ≥1 unit of RBC within 6 hours of arrival. Subjects who received ≥ 10 units within 24 hours of admission were classified as MT patients. Trauma surgeons were asked the clinical gestalt question “Is the patient likely to be massively transfused?” ten minutes after the patients arrival. The performance of clinical gestalt to predict MT was assessed using chi-square tests and ROC analysis to compare gestalt to previously described scoring systems. Results Of the 1,245 patients enrolled, 966 met inclusion criteria and 221 (23%) patients received MT. 415 (43%) were predicted to have a MT and 551(57%) were predicted to not have MT. Patients predicted to have MT were younger, more often sustained penetrating trauma, had higher ISS scores, higher heart rates, and lower systolic blood pressures (all p < 0.05). Gestalt sensitivity was 65.6% and specificity was 63.8%. PPV and NPV were 34.9% and 86.2% respectively. Conclusion Data from this large multicenter trial demonstrates that predicting the need for MT continues to be a challenge. Because of the increased mortality associated with delayed therapy, a more reliable algorithm is needed to identify and treat these severely injured patients earlier. Level of Evidence II; Diagnostic study - Development of diagnostic criteria on basis of consecutive patients (with universally applied reference standard)

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“…However, closure of the open abdomen depends on the method used for temporary abdominal wall closure [3,8,9] , the capacity of tissues for healing without tension, and whether or not enteroatmospheric fistulas are present.…”

Section: Intentional (Planned) Acute Poawmentioning

confidence: 99%

“…Once the therapeutic objective has been achieved, closure of the musculofascial layers should be performed [3,4,[8][9][10] . However, closure of the open abdomen depends on the method used for temporary abdominal wall closure [3,8,9] , the capacity of tissues for healing without tension, and whether or not enteroatmospheric fistulas are present.…”

Section: Intentional (Planned) Acute Poawmentioning

confidence: 99%

“…The capacity of tissues for healing without tension depends on wound-related factors and the patient's general condition [11] . Independently of the technique used for temporary abdominal wall closure, there is a limited window of 2-3 wk to assess early vs delayed closure [8][9][10][11]13,14] . Early definitive closure (final closure of the abdominal defect within the window of 2-3 wk) is based on the resolution of interstitial edema and the evidence of non-adherence between the bowel loops and the abdominal wall.…”

Section: Intentional (Planned) Acute Poawmentioning

confidence: 99%

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“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

López-Cano

Pereira

Armengol

2013

WJGS

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The so-called "burst abdomen" has been described for many years and is a well-known clinical condition, whereas the concept of the "open abdomen" is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of "acute postoperative open abdominal wall" (acute POAW) is presented, which in turn can be divided into "intentional" or planned acute POAW and "unintentional" or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.

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Open abdominal management after damage-control laparotomy for trauma

Abstract: Prognostic study, level III.

Cited by 149 publications

References 20 publications

The effect of damage control laparotomy on major abdominal complications: A matched analysis

The effect of damage control laparotomy on major abdominal complications: A matched analysis

Clinical gestalt and the prediction of massive transfusion after trauma

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

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