BACKGROUND: Damage-control surgery frequently results in open abdomen. The objective of this study was to determine whether resuscitation with goal-directed fluid therapy (GDT) using "dynamic" hemodynamic indices via modern pulse contour analysis devices such as the FloTrac Vigileo monitor leads to lower fluid requirements, subsequent quicker abdominal closure, and overall improved outcomes in these patients. METHODS: Patients admitted to the surgical intensive care unit with open abdomen were retrospectively reviewed. Those resuscitated with Vigileo-guided GDT were matched to those resuscitated by static clinical parameters. RESULTS: Total fluid intake and vasopressor requirements were similar in both groups. GDT with the Vigileo allowed earlier lactate clearance and reduced the number of days until abdominal wall closure by an average of .99 days. CONCLUSIONS: Vigileo-mediated GDT did not affect fluid volume or vasopressor use in open abdomen patients, but facilitated more effective resuscitation and decreased the number of days to fascial closure, leading to shorter hospital stays. Vigileo-mediated GDT, therefore, may improve overall outcomes in open abdomen patients.
BACKGROUND: Damage-control surgery frequently results in open abdomen. The objective of this study was to determine whether resuscitation with goal-directed fluid therapy (GDT) using "dynamic" hemodynamic indices via modern pulse contour analysis devices such as the FloTrac Vigileo monitor leads to lower fluid requirements, subsequent quicker abdominal closure, and overall improved outcomes in these patients. METHODS:Patients admitted to the surgical intensive care unit with open abdomen were retrospectively reviewed. Those resuscitated with Vigileo-guided GDT were matched to those resuscitated by static clinical parameters. RESULTS: Total fluid intake and vasopressor requirements were similar in both groups. GDT with the Vigileo allowed earlier lactate clearance and reduced the number of days until abdominal wall closure by an average of .99 days. CONCLUSIONS: Vigileo-mediated GDT did not affect fluid volume or vasopressor use in open abdomen patients, but facilitated more effective resuscitation and decreased the number of days to fascial closure, leading to shorter hospital stays. Vigileo-mediated GDT, therefore, may improve overall outcomes in open abdomen patients.
Authors: Maryna Masyuk; Bernhard Wernly; Michael Lichtenauer; Marcus Franz; Bjoern Kabisch; Johanna M Muessig; Georg Zimmermann; Alexander Lauten; P Christian Schulze; Uta C Hoppe; Malte Kelm; Jan Bakker; Christian Jung Journal: Intensive Care Med Date: 2018-11-26 Impact factor: 17.440
Authors: Federico Coccolini; Derek Roberts; Luca Ansaloni; Rao Ivatury; Emiliano Gamberini; Yoram Kluger; Ernest E Moore; Raul Coimbra; Andrew W Kirkpatrick; Bruno M Pereira; Giulia Montori; Marco Ceresoli; Fikri M Abu-Zidan; Massimo Sartelli; George Velmahos; Gustavo Pereira Fraga; Ari Leppaniemi; Matti Tolonen; Joseph Galante; Tarek Razek; Ron Maier; Miklosh Bala; Boris Sakakushev; Vladimir Khokha; Manu Malbrain; Vanni Agnoletti; Andrew Peitzman; Zaza Demetrashvili; Michael Sugrue; Salomone Di Saverio; Ingo Martzi; Kjetil Soreide; Walter Biffl; Paula Ferrada; Neil Parry; Philippe Montravers; Rita Maria Melotti; Francesco Salvetti; Tino M Valetti; Thomas Scalea; Osvaldo Chiara; Stefania Cimbanassi; Jeffry L Kashuk; Martha Larrea; Juan Alberto Martinez Hernandez; Heng-Fu Lin; Mircea Chirica; Catherine Arvieux; Camilla Bing; Tal Horer; Belinda De Simone; Peter Masiakos; Viktor Reva; Nicola DeAngelis; Kaoru Kike; Zsolt J Balogh; Paola Fugazzola; Matteo Tomasoni; Rifat Latifi; Noel Naidoo; Dieter Weber; Lauri Handolin; Kenji Inaba; Andreas Hecker; Yuan Kuo-Ching; Carlos A Ordoñez; Sandro Rizoli; Carlos Augusto Gomes; Marc De Moya; Imtiaz Wani; Alain Chichom Mefire; Ken Boffard; Lena Napolitano; Fausto Catena Journal: World J Emerg Surg Date: 2018-02-02 Impact factor: 5.469