Abdominal negative-pressure therapy: a new method in countering abdominal compartment and peritonitis - prospective study and critical review of literature

Haralds Plaudis, Agris Rudzats, Liene Melberga, Ita Kazaka, Olegs Suba, Guntars Pupelis, Haralds Plaudis, Agris Rudzats, Liene Melberga, Ita Kazaka, Olegs Suba, Guntars Pupelis

Abstract

Background: Application of abdominal negative-pressure therapy (NPT) is lifesaving when conservative measures fail to reduce sustained increase of the intra-abdominal pressure and it is impossible to achieve source control in a single operation due to severe peritonitis. The aim of this study is to share the initial experience with abdominal NPT in Latvia and provide a review of the relevant literature.

Methods: In total, 22 patients were included. All patients were treated with KCI® ABThera™ NPT systems. Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission, daily sequential organ failure assessment score and Mannheim peritonitis index (MPI) were calculated for severity definition. The frequency of NPT system changes, daily amount of aspirated fluid effluent and the time of abdominal closure were assessed. The overall hospital and ICU stay, as well as the outcomes and the complication rate, were analysed.

Results: A complicated intra-abdominal infection was treated in 18 patients. Abdominal compartment syndrome due to severe acute pancreatitis (SAP), secondary ileus and damage control in polytrauma were indications for NPT in four patients. The median age of the patients was 59 years (range, 28 to 81), median APACHE II score was 15 points (range, 9 to 32) and median MPI was 28 points (range, 21 to 40), indicating a prognostic mortality risk of 60%. Sepsis developed in all patients, and in 20 of them, it was severe. NPT systems were changed on a median of every 4 days, and abdominal closure was feasible on the seventh postoperative day without needing a repeated laparotomy. Two NPT systems were removed due to bleeding from the retroperitoneal space in patients with SAP. Intestinal fistulae developed in three patients that were successfully treated conservatively. Incisional hernia occurred in three patients. The overall ICU and hospital stay were 14 (range, 5 to 56) and 25 days (range, 10 to 87), respectively. Only one patient died, contributing to the overall mortality of 4.5%.

Conclusions: Application of abdominal NPT could be a very promising technique for the control of sustained intra-abdominal hypertension and management of severe sepsis due to purulent peritonitis. Further trials are justified for a detailed evaluation of abdominal NPT indications.

Figures

Figure 1
Figure 1
Dynamics of CRP and regression of MODS during abdominal NPT.

References

    1. 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. doi: 10.1007/s00268-008-9867-3.
    1. Haldipur N, Cooper B, Sanyal S. Managing the open abdomen. J R Army Med Corps. 2006;152:143–147.
    1. Björck M, Bruhin A, Cheatham M, Hinch D, Kaplan M, Manca G, Wild T, Windsor A. Classification, an important step to improve the management of patients with an open abdomen. World J Surg. 2009;33:1154–1157. doi: 10.1007/s00268-009-9996-3.
    1. Batacchi S, Matano S, Nella A, Zagli G, Bonizzoli M, Pasquini A, Anichini V, Tucci V, Manca G, Ban K, Valeri A, Peris A. Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. Crit Care. 2009;13:194–202. doi: 10.1186/cc8033.
    1. Kaplan M, Banwell P, Orgill DP, Ivatury RR, Moore FA, Miller P, Nicholas J, Henry S. Guidelines for the management of the open abdomen. Wounds. 2005;17:1–24.
    1. Pupelis G, Plaudis H, Grigane A, Zeiza K, Purmalis G. Continuous veno-venous haemofiltration in the treatment of severe acute pancreatitis: 6-year experience. HPB (Oxford) 2007;9:295–301. doi: 10.1080/13651820701329225.
    1. Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med. 1998;26:1793–1800. doi: 10.1097/00003246-199811000-00016.
    1. Wacha H, Linder MM, Feldmann U, Wesch G, Gundlach E, Steifensand RA. Mannheim peritonitis index--prediction of risk of death from peritonitis. Theoretical Surg. 1987;1:169–177.
    1. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi 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. doi: 10.1007/s00134-006-0349-5.
    1. Amin AI, Shaikh IA. Topical negative pressure in managing severe peritonitis: a positive contribution? World J Gastroenterol. 2009;15(Suppl 27):3394–3397.
    1. Kritayakirana K, Maggio PM, Brundage S, Purtill MA, Staudenmayer K, Spain DA. Outcomes and complications of open abdomen technique for managing non-trauma patients. J Emerg Trauma Shock. 2010;3:118–122. doi: 10.4103/0974-2700.62106.
    1. Preston G. An overview of topical negative pressure therapy in wound care. Nurs Stand. 2008;23:62–64.
    1. Eyileten Z, Akar AR, Eryilmaz S, Sirlak M, Yazicioglu L, Durdu S, Uysalel A, Ozyurda U. Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery. Surg Today. 2009;39:947–954. doi: 10.1007/s00595-008-3982-5.
    1. Radhakrishnan RS, Xue H, Weisbrodt N, Moore FA, Allen SJ, Laine GA, Cox CS. Resuscitation-induced intestinal edema decreases the stiffness and residual stress of the intestine. Shock. 2005;24:165–170. doi: 10.1097/01.shk.0000168873.45283.4c.
    1. Rezende-Neto JB, Moore EE, Masuno T, Moore PK, Johnson JL, Sheppard FR, Cunha-Melo JR, Silliman CC. The abdominal compartment syndrome as a second insult during systemic neutrophil priming provokes multiple organ injury. Shock. 2003;20:303–308. doi: 10.1097/01.shk.0000082487.34705.d3.
    1. Shah SK, Jimenez F, Walker PA, Xue H, Feeley TD, Uray KS, Norbury KC, Stewart RH, Laine GA, Cox CS. Peritoneal fluid: a potential mechanism of systemic neutrophil priming in experimental intra-abdominal sepsis. Am J Surg. 2012;203:211–216. doi: 10.1016/j.amjsurg.2010.12.012.
    1. Richard SH, Irene EK. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348:138–150. doi: 10.1056/NEJMra021333.
    1. Kubiak BD, Albert SP, Gatto LA, Snyder KP, Maier KG, Vieau CJ, Roy S, Nieman GF. Peritoneal negative pressure therapy prevents multiple organ injury in a chronic porcine sepsis and ischemia/reperfusion model. Shock. 2010;34:525–534. doi: 10.1097/SHK.0b013e3181e14cd2.
    1. Benninger E, Labler L, Seifert B, Trentz O, Menger MD, Meier C, Moore-Olufemi SD, Xue H, Allen SJ, Moore FA, Stewart RH, Laine GA, Cox CS. In vitro comparison of intra-effects of primary and secondary intra-abdominal hypertension on mesenteric lymph flow: implications for the abdominal compartment syndrome. J Surg Res. 2008;144:102–106. doi: 10.1016/j.jss.2007.02.021.
    1. Bokesch PM, Kapural MB, Mossad EB, Cavaglia M, Appachi E, Drummond-Webb JJ, Mee RBB. Do peritoneal catheters remove pro-inflammatory cytokines after cardiopulmonary bypass in neonates? Ann Thorac Surg. 2000;70:639–643. doi: 10.1016/S0003-4975(00)01453-3.
    1. Moore-Olufemi SD, Xue H, Allen SJ, Moore FA, Stewart RH, Laine GA, Cox CS. Effects of primary and secondary intra-abdominal hypertension on mesenteric lymph flow: implications for the abdominal compartment syndrome. Shock. 2005;23:571–575.
    1. Kowal-Vern A, Ortegel J, Bourdon P, Chakrin A, Latenser BA, Kimball D, Casey LC. Elevated cytokine levels in peritoneal fluid from burned patients with intra-abdominal hypertension and abdominal compartment syndrome. Burns. 2006;32:563–569. doi: 10.1016/j.burns.2005.12.010.
    1. Garner GB, Ware DN, Cocanour CS, Duke JH, McKinley BA, Kozar RA, Moore FA. Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg. 2001;182:630–638. doi: 10.1016/S0002-9610(01)00786-3.
    1. Horwood J, Akabar F, Maw A. Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. Ann R Coll Surg Engl. 2009;91:681–687. doi: 10.1308/003588409X12486167520993.
    1. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg. 2010;5(Suppl 9):1–20.
    1. Schmelzle M, Alldinger I, Matthaei H, Aydin F, Wallert I, Eisenberger CF, Schulte E, Dizdar L, Topp SA, Yang Q, Knoefel WT. Long-term vacuum-assisted closure in open abdomen due to secondary peritonitis: a retrospective evaluation of a selected group of patients. Dig Surg. 2010;27(Suppl 4):272–278.
    1. Keramati M, Srivastava A, Sakabu S, Rumbolo P, Smock M, Pollack J, Troop B. The Wittmann patch as a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn. Burns. 2008;34:493–497. doi: 10.1016/j.burns.2007.06.024.
    1. Petersson U, Acosta S, Björck M. Vacuum-assisted wound closure and mesh-mediated fascial traction--a novel technique for late closure of the open abdomen. World J Surg. 2007;31:2133–2137. doi: 10.1007/s00268-007-9222-0.
    1. Cheatham ML, Malbrain MLNG, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Wilmer A. Results from international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Int Care Med. 2007;33:951–962. doi: 10.1007/s00134-007-0592-4.
    1. Shah SK, Jimenez F, Letourneau PA, Walker PA, Moore-Olufemi SD, Stewart RH, Laine GA, Cox CS. Strategies for modulating the inflammatory response after decompression from abdominal compartment syndrome. Scand J Trauma Resusc Emerg Med. 2012;20:25. doi: 10.1186/1757-7241-20-25.
    1. Benninger E, Labler L, Seifert B, Trentz O, Menger MD, Meier C. Abdominal hypertension development after different temporary abdominal closure techniques. J Surg Res. 2008;144:102–106. doi: 10.1016/j.jss.2007.02.021.
    1. Verdam FJ, Dolmans DE, Loos MJ, Raber MH, de Wit RJ, Charbon JA, Vroemen JP. Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg. 2011;35:2348–2355. doi: 10.1007/s00268-011-1210-8.
    1. Barker DE, Green JM, Maxwell RA, Smith PW, Mejia VA, Dart BW, Cofer JB, Roe SM, Burns RP. Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg. 2007;204:784–792. doi: 10.1016/j.jamcollsurg.2006.12.039.
    1. Hlebowicz J, Hansson J, Lindstedt S. Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen. Int J Colorectal Dis. 2012;27:397–403. doi: 10.1007/s00384-011-1317-2.
    1. Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma. 2000;48:201–206. doi: 10.1097/00005373-200002000-00001.
    1. Shaikh IA, Ballard-Wilson A, Yalamarthi S, Amin AI. Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae. Colorectal Dis. 2010;12(Suppl 9):931–934.
    1. Ivatury RR. Update on open abdomen management: achievements and challenges. World J Surg. 2009;33:1150–1153. doi: 10.1007/s00268-009-0005-7.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться