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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2013 Aprile;79(4):349-59
Intensive care of patients requiring open abdomen treatment: a case-series analysis
Spanu P. 1, Zanforlin G. 1, Noto A. 1, Pezzi A. 1, Marzorati S. 1, Reali-Forster C. 1, Di Mauro P. 1, Bassi G. 1, 2, Oldani S. 1, Destrebecq A. 3, Iapichino G. 1, 4 ✉
1 Servizio di Anestesia e Rianimazione Polo Universitario San Paolo, Milano, Italy;
2 Servizio di Anestesia e Rianimazione, Ospedale Niguarda, Milano, Italia;
3 Dipartimento di Salute Pubblica, Microbiologia e Virologia, Università degli Studi di Milano, Milan, Italy;
4 Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
Background: This retrospective overview examines the management of patients with temporary open abdomen (OA).
Methods: The clinical characteristics and intensive care treatment of 34 consecutive patients with OA (1996-2012) were reviewed.
Results: Average age was 61 years, SAPS II score 43, SOFA 8. Two patients had non-contaminated abdomen; 12 had intact gut (only 8 later during stay); 7 repaired gut (only later 4); 13 cutaneous stoma (later 14), and 2 entero-atmospheric fistula (later 8+1 entero-enteral). The median ICU stay was 48 [36-94] days. One quarter of the 2376 ICU-days were classified as severe sepsis/septic shock (antibiotics were given for two thirds of the stay); three quarters were with ventilation; in 95% of days sedatives were given (mainly enterally). Continuous cavity lavage was done in three quarters of days; in 3% of days patients were fasted whereas >20 kcal/kg was given for 74% of days; we fed the gut in 95% of fed-days, in half of them combined with parenteral nutrition. Complications are discussed; mortality was 32.4%, limited to the ICU stay.
Conclusion: The intensive care of patients with OA is challenging but can achieve better outcomes than expected. Continuous abdominal lavage improves the evacuation of contaminated fluid or debris and, coupled with antiseptics and low antibiotic pressure, reinforces the control of infection. The gut can be used for nutrition (even without gastrointestinal continuity), and long-term light sedation (mainly enteral) with minimal impact on perfusion, ventilation and gut motility.