Comparison between open and open-vacuum-assisted closure treatment in the adjuvant treatment of the abdominal compartment syndrome

Introduction

Abdominal compartment syndrome (ACS) represents a potentially life-threatening condition in critically ill patients. The control of intra-abdominal pressure (IAP) plays a pivotal role in prevention/treatment of ACS. We compared the efficacy of two different therapies – open and open-vacuum-assisted closure (open-VAC) treatment [1] – on resolution of intra-abdominal hypertension/prevention of ACS.

Methods

We prospectively analyzed data of 26 consecutive patients admitted to the ICU of our emergency department (Careggi Teaching Hospital, Florence) with sepsis from an abdominal source, hemorrhagic shock, and major trauma. All patients underwent laparotomic surgery before ICU admission with open-VAC treatment. As a control group we retrospective analyzed 17 patients admitted with the same diagnosis and treated with open treatment. IAP was evaluated by measuring the urinary bladder pressure [2]. Patients' demographic and clinical characteristics, and laboratory parameters were collected from the ICU database (FileMaker Pro 5.5v2; FileMaker, Inc., USA) with authorization of the Careggi Teaching Hospital Committee of the Emergency Department. For each patient, data were collected before the surgical treatment with a closed abdomen (T1), 6 hours after ICU admission (T6), after 24 hours (T24), 24 hours after abdomen closing (T24C), and at monitoring suspension (TMS). Statistical analysis: Student's t test (*P < 0.05). Data reported as the mean ± SD.

Results

The two groups were similar in demographic and clinical characteristics. The open-VAC group patients showed a significantly shorter length of stay in the ICU (open: 20.58 ± 15.97; VAC: 11.46 ± 11.99) and had a shorter time before laparotomy closure (open: 6.82 ± 3.85; VAC: 4.57 ± 2.88) if compared with the control group. Finally, both IAP values from T1 (open: 17.9 ± 6.41; open-VAC: 15.1 ± 5.68) to T24C (open: 15.7 ± 3.4; open-VAC: 12.6 ± 2.63) and lactate levels from T1 (open: 6.34 ± 4.65; open-VAC: 4.1 ± 3.1) to T6 (open: 5.72 ± 5.71; open-VAC:2.62 ± 2.08) and T24 (open: 5.66 ± 5.81; open-VAC: 2.15 ± 2.12) were significantly lower in a time-dependent manner in the open-VAC group.

Conclusion

The present study suggests that the open-VAC could have more beneficial effects than the traditional open technique in the treatment of patients with intra-abdominal hypertension/ACS.