Prospective Study Examining Clinical Outcomes Associated with a Negative Pressure Wound Therapy System and Barker’s Vacuum Packing Technique

Michael L Cheatham,Timothy C Fabian,Mark J Kaplan,Demetrios Demetriades,William S Miles,Martin A Schreiber,John B Holcomb,Michael F Rotondo,Babak Sarani,Grant Bochicchio

doi:10.1007/s00268-013-2080-z

Abstract

BackgroundThe open abdomen has become a common procedure in the management of complex abdominal problems and has improved patient survival. The method of temporary abdominal closure (TAC) may play a role in patient outcome.MethodsA prospective, observational, open-label study was performed to evaluate two TAC techniques in surgical and trauma patients requiring open abdomen management: Barker’s vacuum-packing technique (BVPT) and the ABTheraTM open abdomen negative pressure therapy system (NPWT). Study endpoints were days to and rate of 30-day primary fascial closure (PFC) and 30-day all-cause mortality.ResultsAltogether, 280 patients were enrolled from 20 study sites. Among them, 168 patients underwent at least 48 hours of consistent TAC therapy (111 NPWT, 57 BVPT). The two study groups were well matched demographically. Median days to PFC were 9 days for NPWT versus 12 days for BVPT (p = 0.12). The 30-day PFC rate was 69 % for NPWT and 51 % for BVPT (p = 0.03). The 30-day all-cause mortality was 14 % for NPWT and 30 % for BVPT (p = 0.01). Multivariate logistic regression analysis identified that patients treated with NPWT were significantly more likely to survive than the BVPT patients [odds ratio 3.17 (95 % confidence interval 1.22–8.26); p = 0.02] after controlling for age, severity of illness, and cumulative fluid administration.ConclusionsActive NPWT is associated with significantly higher 30-day PFC rates and lower 30-day all-cause mortality among patients who require an open abdomen for at least 48 h during treatment for critical illness.

Highlights

The ‘‘open abdomen’’ (OA) and temporary abdominal closure (TAC) techniques have become valuable tools in the surgeon’s armamentarium
Multivariate logistic regression analysis identified that patients treated with negative pressure wound therapy (NPWT) were significantly more likely to survive than the Barker’s vacuum-packing technique (BVPT) patients [odds ratio 3.17 (95 % confidence interval 1.22–8.26); p = 0.02] after controlling for age, severity of illness, and cumulative fluid administration
Active NPWT is associated with significantly higher 30-day primary fascial closure (PFC) rates and lower 30-day all-cause mortality among patients who require an open abdomen for at least 48 h during treatment for critical illness

Summary

Introduction

The ‘‘open abdomen’’ (OA) and temporary abdominal closure (TAC) techniques have become valuable tools in the surgeon’s armamentarium. They are part of damage control strategies and are used in the treatment of abdominal sepsis and intraabdominal hypertension (IAH)/ abdominal compartment syndrome (ACS). Management of the OA in a patient with concomitant critical illness is challenging It is associated with the potential for marked fluid loss, infection, visceral perforation, organ dysfunction, and death [6,7,8,9,10,11,12,13]. Demetriades Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA

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