Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker's vacuum packing technique

Michael L Cheatham, Demetrios Demetriades, Timothy C Fabian, Mark J Kaplan, William S Miles, Martin A Schreiber, John B Holcomb, Grant Bochicchio, Babak Sarani, Michael F Rotondo, Michael L Cheatham, Demetrios Demetriades, Timothy C Fabian, Mark J Kaplan, William S Miles, Martin A Schreiber, John B Holcomb, Grant Bochicchio, Babak Sarani, Michael F Rotondo

Abstract

Background: The open abdomen has become a common procedure in the management of complex abdominal problems and has improved patient survival. The method of temporary abdominal closure (TAC) may play a role in patient outcome.

Methods: A prospective, observational, open-label study was performed to evaluate two TAC techniques in surgical and trauma patients requiring open abdomen management: Barker's vacuum-packing technique (BVPT) and the ABThera(TM) open abdomen negative pressure therapy system (NPWT). Study endpoints were days to and rate of 30-day primary fascial closure (PFC) and 30-day all-cause mortality.

Results: Altogether, 280 patients were enrolled from 20 study sites. Among them, 168 patients underwent at least 48 hours of consistent TAC therapy (111 NPWT, 57 BVPT). The two study groups were well matched demographically. Median days to PFC were 9 days for NPWT versus 12 days for BVPT (p = 0.12). The 30-day PFC rate was 69 % for NPWT and 51 % for BVPT (p = 0.03). The 30-day all-cause mortality was 14 % for NPWT and 30 % for BVPT (p = 0.01). Multivariate logistic regression analysis identified that patients treated with NPWT were significantly more likely to survive than the BVPT patients [odds ratio 3.17 (95 % confidence interval 1.22-8.26); p = 0.02] after controlling for age, severity of illness, and cumulative fluid administration.

Conclusions: Active NPWT is associated with significantly higher 30-day PFC rates and lower 30-day all-cause mortality among patients who require an open abdomen for at least 48 h during treatment for critical illness.

Figures

Fig. 1
Fig. 1
Barker’s vacuum-packing technique consists of a fenestrated, nonadherent polyethylene sheet placed over the viscera and covered with moist surgical towels or gauze. Two drains are placed over the towels/gauze. The wound is then sealed with an occlusive dressing and connected to wall suction (with permission from KCI Licensing, Inc.)
Fig. 2
Fig. 2
ABTheraTM open-abdomen negative-pressure therapy system, commercially available, is composed of a reusable negative pressure source (ABTheraTM pump), a visceral protective layer dressing composed of a nonadherent sheet with encapsulated foam struts, a sheet of polyurethane foam, an adherent elastic barrier layer, and a tubing set to connect the negative-pressure source to the dressing (with permission from KCI Licensing, Inc.)
Fig. 3
Fig. 3
Consolidated Standards of Reporting Trials (CONSORT) statement. BVPT Barker’s vacuum packing technique, NPWT negative-pressure wound therapy, TAC temporary abdominal closure
Fig. 4
Fig. 4
Kaplan–Meier plot of time to death for the TAC ≥ 48 h population

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