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World Journal of Surgery

, Volume 42, Issue 10, pp 3210–3214 | Cite as

Trauma Patients with an Open Abdomen Following Damage Control Laparotomy can be Extubated Prior to Abdominal Closure

  • Joseph A. Sujka
  • Karen Safcsak
  • Michael L. Cheatham
  • Joseph A. Ibrahim
Original Scientific Report

Abstract

Background

The open abdomen (OA) is commonly utilized as a technique during damage control laparotomy (DCL). We propose that a selected group of these OA patients can be extubated prior to abdominal closure to decrease ventilator days and risk of pneumonia.

Methods

A retrospective chart review was performed at a Level I trauma center on all adult trauma patients with an OA following DCL. Patients were stratified into two groups: extubated prior to (PRE) and extubated after (POST) abdominal closure. Successful extubation in the PRE group was measured by the absence of re-intubation. The two groups were compared using the Mann–Whitney U and Fisher’s exact tests. Multivariate logistic regression identified independent predictors for successful extubation prior to abdominal closure.

Results

Thirty-one patients were in the PRE group, and 59 patients in the POST group. There were no differences between the groups with regard to age, gender, or hours from admission to completion of DCL. The PRE group had a significantly higher incidence of penetrating trauma (77 vs. 53%; p = 0.02), a significantly lower number of days from OA to extubation [0.6 (0.2–1.1) vs. 3.4 (2–-8) days; p < 0.001], and a significant decrease in pneumonia (10 vs. 31%; p = 0.04). Two patients in each group required re-intubation [PRE (6%) vs. POST (3%); p = 0.61]. In a multivariate binominal logistic regression, penetrating trauma (p = 0.024), GCS on admission (p < 0.0001), and Injury Severity Score (p = 0.024) were identified as independent predictors for successful extubation.

Conclusion

Presence of an OA following DCL does not require mechanical ventilation. Extubation of appropriate trauma patients prior to abdominal closure decreases pneumonia and hospital length of stay.

Notes

Author contributions

JAS MD contributed in literature search, study design, data collection, data interpretation, writing, and editing. KS, RN, BSN helped in study design, data collection, data analysis, data interpretation, writing, tables, editing, corrections, and submission. MLC, MD, FACS contributed in study design, data interpretation, writing, and editing. JAI, MD, FACS were involved in study design, data interpretation, and editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Joseph A. Sujka
    • 1
  • Karen Safcsak
    • 1
  • Michael L. Cheatham
    • 1
  • Joseph A. Ibrahim
    • 1
  1. 1.Department of Surgical EducationOrlando Regional Medical CenterOrlandoUSA

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