Trauma Patients with an Open Abdomen Following Damage Control Laparotomy can be Extubated Prior to Abdominal Closure
The open abdomen (OA) is commonly utilized as a technique during damage control laparotomy (DCL). We propose that a selected group of these OA patients can be extubated prior to abdominal closure to decrease ventilator days and risk of pneumonia.
A retrospective chart review was performed at a Level I trauma center on all adult trauma patients with an OA following DCL. Patients were stratified into two groups: extubated prior to (PRE) and extubated after (POST) abdominal closure. Successful extubation in the PRE group was measured by the absence of re-intubation. The two groups were compared using the Mann–Whitney U and Fisher’s exact tests. Multivariate logistic regression identified independent predictors for successful extubation prior to abdominal closure.
Thirty-one patients were in the PRE group, and 59 patients in the POST group. There were no differences between the groups with regard to age, gender, or hours from admission to completion of DCL. The PRE group had a significantly higher incidence of penetrating trauma (77 vs. 53%; p = 0.02), a significantly lower number of days from OA to extubation [0.6 (0.2–1.1) vs. 3.4 (2–-8) days; p < 0.001], and a significant decrease in pneumonia (10 vs. 31%; p = 0.04). Two patients in each group required re-intubation [PRE (6%) vs. POST (3%); p = 0.61]. In a multivariate binominal logistic regression, penetrating trauma (p = 0.024), GCS on admission (p < 0.0001), and Injury Severity Score (p = 0.024) were identified as independent predictors for successful extubation.
Presence of an OA following DCL does not require mechanical ventilation. Extubation of appropriate trauma patients prior to abdominal closure decreases pneumonia and hospital length of stay.
JAS MD contributed in literature search, study design, data collection, data interpretation, writing, and editing. KS, RN, BSN helped in study design, data collection, data analysis, data interpretation, writing, tables, editing, corrections, and submission. MLC, MD, FACS contributed in study design, data interpretation, writing, and editing. JAI, MD, FACS were involved in study design, data interpretation, and editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 6.Spencer SM, Cheatham ML. Prevention and diagnosis of ventilator associated pneumonia. http://www.surgicalcriticalcare.net/Guidelines/Ventilatorassociated pneumonia.pdf. Updated February 24, 2016. Accessed 05 March 2017