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Negative-pressure wound therapy for critically ill adults with open abdominal wounds: A systematic review

Roberts, Derek J. MD; Zygun, David A. MD, MSc, FRCPC; Grendar, Jan MD; Ball, Chad G. MD, MSc; Robertson, Helen Lee MLIS; Ouellet, Jean-Francois MD; Cheatham, Michael L. MD; Kirkpatrick, Andrew W. MD, MHSc

Journal of Trauma and Acute Care Surgery: September 2012 - Volume 73 - Issue 3 - p 629–639
doi: 10.1097/TA.0b013e31825c130e
TAC 2012 Plenary Paper
EBRS Journal Club

BACKGROUND Open abdominal management with negative-pressure wound therapy (NPWT) is increasingly used for critically ill trauma and surgery patients. We sought to determine the comparative efficacy and safety of NPWT versus alternate temporary abdominal closure (TAC) techniques in critically ill adults with open abdominal wounds.

METHODS We conducted a systematic review of published and unpublished comparative studies. We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, the Cochrane Database, the Center for Reviews and Dissemination, clinical trials registries, and bibliographies of included articles. Two authors independently abstracted data on study design, methodological quality, patient characteristics, and outcomes.

RESULTS Among 2,715 citations identified, 2 randomized controlled trials and 9 cohort studies (3 prospective/6 retrospective) met inclusion criteria. Methodological quality of included prospective studies was moderate. One randomized controlled trial observed an improved fascial closure rate (relative risk [RR], 2.4; 95% confidence interval [CI], 1.0–5.3) and length of hospital stay after addition of retention sutured sequential fascial closure to the Kinetic Concepts Inc. (KCI) vacuum-assisted closure (VAC). Another reported a trend toward enhanced fascial closure using the KCI VAC versus Barker’s vacuum pack (RR, 2.6; 95% CI, 0.95–7.1). A prospective cohort study observed improved mortality (RR, 0.48; 95% CI, 0.25–0.92) and fascial closure (RR, 1.5; 95% CI, 1.1–2.0) for patients who received the ABThera versus Barker’s vacuum pack. Another noted a reduced arterial lactate, intra-abdominal pressure, and hospital stay for those fitted with the KCI VAC versus Bogotá bag. Most included retrospective studies exhibited low methodological quality and reported no mortality or fascial closure benefit for NPWT.

CONCLUSION Limited prospective comparative data suggests that NPWT versus alternate TAC techniques may be linked with improved outcomes. However, the clinical heterogeneity and quality of available studies preclude definitive conclusions regarding the preferential use of NPWT over alternate TAC techniques.

LEVEL OF EVIDENCE Systematic review, level III.

From the Department of Surgery (D.J.R., J.G., C.G.B., J.-F.O., A.W.K.), Department of Community Health Sciences (D.J.R., D.A.Z.), Department of Critical Care Medicine (D.J.R., D.A.Z., A.W.K.), Department of Clinical Neurosciences (D.A.Z.), Regional Trauma Program (C.G.B., J.-F.O., A.W.K.), Health Sciences Library (H.L.R.), University of Calgary; and the Foothills Medical Centre (D.J.R., D.A.Z., J.G., C.G.B., J.-F.O., A.W.K.), Calgary, Alberta, Canada; Department of Surgical Education (M.L.C.), Orlando Regional Medical Centre, Orlando, Florida.

Submitted: January 16, 2012, Revised: April 20, 2012, Accepted: April 20, 2012.

This study was presented in part at Trauma 2012: The Trauma Association of Canada Annual Scientific Meeting in Toronto, Ontario, Canada on April 12, 2012.

Drs. Roberts, Zygun, and Kirkpatrick had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.

Address for reprints: Andrew W. Kirkpatrick, MD, MHSc, FRCSC, FACS, Departments of Surgery and Critical Care Medicine, University of Calgary, 1403-29th St., Northwest, Calgary, Alberta, Canada, T2N 2T9; email: Andrew.Kirkpatrick@AlbertaHealthServices.Ca.

© 2012 Lippincott Williams & Wilkins, Inc.