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Trauma and emergency general surgery patients should be extubated with an open abdomen

Taveras, Luis R. MD; Imran, Jonathan B. MD; Cunningham, Holly B. MD; Madni, Tarik D. MD; Taarea, Roberto DO; Tompeck, Allison MD; Clark, Audra T. MD; Provenzale, Natalie MPH; Adeyemi, Folarin M.; Minshall, Christian T. MD, PhD; Eastman, Alexander L. MD; Cripps, Michael W. MSCS, MD

Journal of Trauma and Acute Care Surgery: December 2018 - Volume 85 - Issue 6 - p 1043–1047
doi: 10.1097/TA.0000000000002064
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BACKGROUND Open abdomen (OA) and temporary abdominal closure (TAC) are common techniques to manage several surgical problems in trauma and emergency general surgery (EGS). Patients with an OA are subjected to prolonged mechanical ventilation. This can lead to increased rates of ventilator-associated pneumonia (VAP). We hypothesized that patients who were extubated with an OA would have a decrease in ventilator hours and as a result would have a lower rate of VAP without an increase in extubation failures.

METHODS A retrospective review was performed of all trauma and EGS patients managed at our institution with OA and TAC from January 2014 to February 2016. Patients were divided into cohorts consisting of those who were successfully extubated with an OA and those who were not. The number of extubation events and ventilator-free hours were calculated for each patient. Adverse events such as the need for reintubation with an OA and VAP were collected.

RESULTS Fifty-two patients (20 trauma, 32 EGS) were managed with an OA and TAC during the study period. Twenty-five patients (6 trauma, 19 EGS) had at least one extubation event with an OA. Median extubation events per patient was 3 (interquartile range, 1–5). The median ventilator-free hours for patients who were extubated was 101 hours (interquartile range, 39.42–260.46). Patients that were never extubated with an OA had higher rates of VAP (30.8% vs. 3.8%, p = 0.01).

CONCLUSION This study provides much needed data regarding the feasibility of extubation in trauma and EGS patients managed with an OA and TAC. Benefits of early extubation may include lower VAP rates in this population. Plans for reexploration hinder the decision to extubate in these patients.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the The Rees-Jones Trauma Center at Parkland Hospital (L.R.T., J.B.I., H.B.C., T.D.M., R.T., A.T., A.T.C., F.M.A., C.T.M., A.L.E., M.W.C.); the Division of General and Acute Care Surgery, Department of Surgery, (L.R.T., J.B.I., H.B.C., T.D.M., R.T., A.T., A.T.C., F.M.A., C.T.M., A.L.E., M.W.C.), University of Texas Southwestern Medical Center; and Parkland Memorial Hospital (N.P.), Dallas, Texas.

Submitted: May 22, 2018, Accepted: August 30, 2018, Published online: September 11, 2018.

Address for reprints: Michael W. Cripps, MD, UT Southwestern Medical Center, Department of Surgery, Division of General and Acute Care Surgery, 5323 Harry Hines Blvd., E5.508, Dallas, TX 75390-9158; email: Michael.Cripps@utsouthwestern.edu.

This original work was presented as a poster at the 30th Eastern Association for the Surgery of Trauma Annual Scientific Assembly held January 10–14, 2017, and has not been submitted or published elsewhere.

© 2018 Lippincott Williams & Wilkins, Inc.