Abstract
The indications for Open Abdomen (OA) are generally all those situations in which is ongoing the development an intra-abdominal hypertension condition (IAH), in order to prevent the development of abdominal compartmental syndrome (ACS). In fact all those involved in care of a critically ill patient should in the first instance think how to prevent IAH and ACS. In case of ACS goal directed therapy to achieve early opening and early closure is the key: paradigm of closure shifts to combination of therapies including negative pressure wound therapy and dynamic closure, in order to reduce complications and avoid incisional hernia.There have been huge studies and progress in survival of critically ill trauma and septic surgical patients: this in part has been through the great work of pioneers, scientific societies and their guidelines; however future studies and continued innovation are needed to better understand optimal treatment strategies and to define more clearly the indications, because OA by itself is still a morbid procedure.
Highlights
The first to describe the use of the open abdomen (OA) technique, in a generalized peritonitis was probably Andrew J
The indications for Open Abdomen are generally trauma, abdominal sepsis, severe acute pancreatitis and in general situations in which is ongoing the development an intra-abdominal hypertension condition (IAH), in order to prevent the development of abdominal compartmental syndrome (ACS)
Starkopf et al found that the risk of IAH in mechanically ventilated patients is very low especially if they have a positive end expiratory pressure (PEEP) < 10 cm H2O, PaO2/FiO2 > 300 and BMI < 30 kg/m2 and without pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding or laparotomy and the use of vasopressor/inotropes at admission [12]
Summary
The first to describe the use of the open abdomen (OA) technique, in a generalized peritonitis was probably Andrew J. McCosh in 1897 [1] This clinical approach to a critically ill patient at that time was unusual and while again referred to by Ogilvie in the mid 1940’s [2] and only recently became popular in patients undergoing damage control surgery (DCS). The indications for Open Abdomen are generally trauma, abdominal sepsis, severe acute pancreatitis and in general situations in which is ongoing the development an intra-abdominal hypertension condition (IAH), in order to prevent the development of abdominal compartmental syndrome (ACS). The concept of abdominal damage control surgery has two basic components; controlling bleeding and contamination in the abdominal cavity, and leaving the abdomen open, to decompress or facilitate return at planned re-laparotomy. Sustained IAP >20 mmHg (with or without APP
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