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Episode 031 Development Of A Comprehensive Guideline To Improve Outcomes In High-Risk Trauma Patients With Open Abdomens
Development of�a Comprehensive Guideline To Improve Outcomes In High-Risk Trauma Patients With Open Abdomens
Kaplan, M., Md, Liebman, J, Md, Wheel, K Md, Bones, K, Rn, Hooper, A, Rn, Servas, P, Rn, And Simms, H Md
Objective: To evaluate a comprehensive multidisciplinary guideline developed to standardize the management of patents with an open abdomen (OA) to improve outcomes.
Methods: Retrospective study on the effectiveness a guideline that was developed at a Level I trauma center to standardize the management trauma patents with OA. Guideline development included: re-definition of the indications for an OA, fluid and blood transfusion guidelines, revised damage control guidelines, expanded use of advanced closure techniques, and expanded use of Vacuum Assisted Closure (VAC). Consensus panel recommendations from two panels were used as well as the definitions of ACS from the WSACS.Two cohorts were evaluated pre and post guideline implementation: Group I (PGL) pre-guideline from 2001-2004; Group II (GL) guideline implementation 2004-2008. Groups were compared for rates of mortality, closure, fistula, multiple organ dysfunction syndrome, intra-abdominal hypertension (IAH), and abdominal compartment syndrome (ACS).
Results: In the study period 456 trauma patents required laparotomy; 27 of 221 laparotomies (12.7%) were in PGL with and of the 236 laparotomies in GL 57 (24.1%) were opened post procedure. Indications to keep the abdomen open were meet in 85% of PGL and 100% in GLgroup. Average ISS was 27 in PGL compared to 24.4 in GL. Closure rates were 70% in PGL with a mean closure time of 23 days and 94% in GL with mean closure time of 6.4 days. Mean IAH for PGL was 29mmHg compared to 16 mmHg in GL (p<. 05). GL group had no reported incidences of ACS compared PGL with 12 patients (45%). PGL had 7 patients (50%) with fistulas compared to 2 (4%) in GL. PGL had VAC therapy in 20% and GL had VAC therapy 100%. There was a 50% incidence of organ failure in the PGL group compared to 4% in GL group. Mortality rates were decreased from 27% in PGL to 17% in GL group (p> .05).
Conclusion: The development of a comprehensive guideline based on established physiologic and contemporary concepts known will enhance and improve the management of trauma patients with an OA improved. Guidelines implementation is effective and had a significant impact in decreasing complications with improved closure rates and decrease in significant complications associated with an open abdomen. Mortality rates decreased but did not meet statistical significance.
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Development of�a Comprehensive Guideline To Improve Outcomes In High-Risk Trauma Patients With Open Abdomens
Kaplan, M., Md, Liebman, J, Md, Wheel, K Md, Bones, K, Rn, Hooper, A, Rn, Servas, P, Rn, And Simms, H Md
Objective: To evaluate a comprehensive multidisciplinary guideline developed to standardize the management of patents with an open abdomen (OA) to improve outcomes.
Methods: Retrospective study on the effectiveness a guideline that was developed at a Level I trauma center to standardize the management trauma patents with OA. Guideline development included: re-definition of the indications for an OA, fluid and blood transfusion guidelines, revised damage control guidelines, expanded use of advanced closure techniques, and expanded use of Vacuum Assisted Closure (VAC). Consensus panel recommendations from two panels were used as well as the definitions of ACS from the WSACS.Two cohorts were evaluated pre and post guideline implementation: Group I (PGL) pre-guideline from 2001-2004; Group II (GL) guideline implementation 2004-2008. Groups were compared for rates of mortality, closure, fistula, multiple organ dysfunction syndrome, intra-abdominal hypertension (IAH), and abdominal compartment syndrome (ACS).
Results: In the study period 456 trauma patents required laparotomy; 27 of 221 laparotomies (12.7%) were in PGL with and of the 236 laparotomies in GL 57 (24.1%) were opened post procedure. Indications to keep the abdomen open were meet in 85% of PGL and 100% in GLgroup. Average ISS was 27 in PGL compared to 24.4 in GL. Closure rates were 70% in PGL with a mean closure time of 23 days and 94% in GL with mean closure time of 6.4 days. Mean IAH for PGL was 29mmHg compared to 16 mmHg in GL (p<. 05). GL group had no reported incidences of ACS compared PGL with 12 patients (45%). PGL had 7 patients (50%) with fistulas compared to 2 (4%) in GL. PGL had VAC therapy in 20% and GL had VAC therapy 100%. There was a 50% incidence of organ failure in the PGL group compared to 4% in GL group. Mortality rates were decreased from 27% in PGL to 17% in GL group (p> .05).
Conclusion: The development of a comprehensive guideline based on established physiologic and contemporary concepts known will enhance and improve the management of trauma patients with an OA improved. Guidelines implementation is effective and had a significant impact in decreasing complications with improved closure rates and decrease in significant complications associated with an open abdomen. Mortality rates decreased but did not meet statistical significance.
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