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

Abstract

IntroductionCritically 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.MethodsThis 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.ResultsThe 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.ConclusionsPatients 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.

Comparison of early surgical alternatives in the management of open abdomen: a randomized controlled study

“…[32] Similarly, the present study revealed a significantly earlier abdominal closure time in the VAC group. Recently, a study by Long and colleagues has evaluated the utility of concomitant therapies for open abdomen by comparing the VAC used in combination with the abdominal re-approximation abdominal wall anchor closure (ABRA) system for closure of open abdomen.…”

Effects of intraabdominal pressure on mean platelet volume during laparoscopic cholecystectomy

“…Cytokine levels, tissue ischemia markers, and/or thrombopoietin levels might be studied to further support the hypothesis of Thomas and Boos as mentioned above. Second, the IAP was kept at 12 mmHg during the study, which corresponds to grade I IAH (grade I = IAP 12 to 15 mmHg, grade II = IAP 16 to 20 mmHg, grade III = IAP 21 to 25 mmHg, grade IV = IAP > 25 mmHg) (2,6,29). If the IAP is increased above this level, it is possible that more significant changes in MPV values would be seen.…”

Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder

“…We described the use of vacuum-assisted dressing (VAC) in the successful management of severe DNM with both involvement of superior and inferior mediastinum. VAC dressing was described commonly in management of complex wound such as osteomyelitis of long bones [10]. It creates negative pressure that helps to remove inflammatory exudates, reduce edema, increase perfusion and promote granulation [11].…”