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Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy

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Abstract

Purpose

To estimate the change in intra-abdominal pressure (IAP) among critically ill patient who were left with open abdomen and temporary abdominal closure after laparotomy, during the first 48 h after admission.

Methods

A cohort study in a single ICU in a tertiary care hospital. All adult patients admitted to the ICU after emergent laparotomy for acute abdomen or trauma, who were left with temporary abdominal closure (TAC), were included. Patients were followed up to 48 h. IAP was routinely measured at 0, 6, 12, 24, and 48 h after admission to ICU.

Results

Thirty-nine patients were included, 34 were operated due to acute abdomen and 5 due to abdominal trauma. Seventeen patients were treated with skin closure, 13 with Bogota bag, and 9 with negative pressure wound therapy (NPWT). Eleven patients (28.2%) had IAP of 15 mmHg or above at time 0, (mean pressure 19.0 ± 3.0 mmHg), and it dropped to 12 ± 4 mmHg within 48 h (p < 0.01). Reduction in lactate level (2.4 ± 1.0 to 1.2 ± 0.2 mmol/L, p < 0.01) and increase in PaO2/FiO2 ratio (163 ± 34 to 231 ± 83, p = 0.03) were observed as well after 48 h.

Conclusions

This is the first large report of IAP in open abdomen. Elevated IAP may be measured in open abdomen and may subsequently relieve after 48 h.

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Author notes

  1. Guetta Ohad and Brotfain Evgeni contributed equally to this work.

Authors and Affiliations

  1. Department General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Be’er Sheva, Israel

    Ohad Guetta, Gilbert Sebbag & David Czeiger

  2. Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Evgeni Brotfain

  3. Head of Trauma Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Gad Shaked

  4. Head of Critical Care Department, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Moti Klein

Authors
  1. Ohad Guetta
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  2. Evgeni Brotfain
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  3. Gad Shaked
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  4. Gilbert Sebbag
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  5. Moti Klein
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  6. David Czeiger
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Contributions

Dr. Guetta made the literature review and writing work. Dr. Brotfain did the data collection. Dr. Shaked designed the study. Dr. Czeiger did data analysis and data interpretation. Dr. Sebbag and Dr. Klein did critical revision over the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ohad Guetta.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The local Institutional Review Board waived the need for informed consent in consideration with the nature of the study.

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Guetta, O., Brotfain, E., Shaked, G. et al. Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy. Langenbecks Arch Surg 405, 91–96 (2020). https://doi.org/10.1007/s00423-020-01854-7

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  • DOI: https://doi.org/10.1007/s00423-020-01854-7

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