Negative pressure therapy improved outcome in a clinically applicable abdominal compartment syndrome porcine model

Introduction

Abdominal compartment syndrome (ACS) is manifested by elevated intra-abdominal pressures (IAP) and associated hemodynamic, lung, or renal dysfunction. ACS may develop in trauma, pancreatitis, or burn patients. Abdominal closure after laparotomy, using negative pressure therapy (NPT) via a reticulated open-cell foam-based dressing, provides indirect negative pressure to the abdominal wall and viscera. We hypothesize that NPT improves hemodynamic, lung, and renal function as compared with a dressing-covered open abdomen without NPT.

Methods

Pigs (25–37 kg) were anesthetized and ventilated. After laparotomy, the superior mesenteric artery was occluded for 30 minutes. The cecum was perforated and a fecal clot was created to induce severe sepsis. Animals received isotonic fluid resuscitation titrated to mean arterial pressure (MAP) > 60 mmHg.

The abdomen was closed at the time of injury, then reopened 12 hours later and the animals were randomized to receive either NPT at -125 mmHg (n = 3) or no NPT (n = 3). Parameters were recorded hourly for 48 hours or until premature death.

Results

The hemodynamics, lung, and renal function were similar prior to application of NPT (T0–T11). The parameters improved after placement of the NPT device (Table 1).

Table 1 Data from T24 through T48

Conclusion

NPT improved physiologic parameters in a clinical model of ACS. NPT is an effective strategy for the treatment of ACS in a severe sepsis model.