Trauma and Emergency General Surgery Patients Should Be Extubated With an Open Abdomen

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 open abdomen 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 (IQR 1-5). The median ventilator-free hours for patients who were extubated was 103 hours (IQR 39.7-229.7). Patients that were never extubated with an open abdomen 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 re-exploration hinder the decision to extubate in these patients. Level of Evidence Therapeutic study, Level IV Corresponding author: Michael W. Cripps, MD, MSCS, FACS, UT Southwestern Medical Center, Department of Surgery, Division of General and Acute Care Surgery, 5323 Harry Hines Blvd., E5.508, Dallas, Texas 75390 – 9158, 214-648-9524, 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. Declaration of interest The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. © 2018 Lippincott Williams & Wilkins, Inc.

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