Abstract
Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a “planned second-look” laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.
Highlights
Damage control management (DCM) of severely injured or physiologically deranged patients is considered by many to consist of damage control resuscitation (DCR) and damage control surgery (DCS)
In other clinical situations, the abdomen cannot be closed due to visceral edema, the inability to completely control the compelling source of infection or to the necessity to re-explore or to complete DCS procedures or in cases of abdominal wall damage
Open abdomen (OA) has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness, it must be recognized as a non-anatomic situation that has potential for severe side effects while increasing resource utilization [3]
Summary
Damage control management (DCM) of severely injured or physiologically deranged patients is considered by many to consist of damage control resuscitation (DCR) and damage control surgery (DCS). Patients undergoing OA management are at risk of developing entero-atmospheric fistula (EAF) and a “frozen abdomen,” intra-abdominal abscesses, and lower rates of definitive fascial closure [6, 7]. Purpose and use of this guideline The guidelines are evidence-based, with the grades of recommendation, based on the evidence These guidelines present methods for optimal management of open abdomen in trauma and non-trauma patients. They do not represent a standard of practice. They, do not exclude other approaches as being within a standard of practice They should not be used to compel adherence to a given method of medical management, which should be determined after taking into account conditions at the relevant medical institution (staff levels, experience, equipment, etc.) and the characteristics of the individual patient. The responsibility for the results, rests with the engaging practitioners and not aged therein, and not the consensus group
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