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

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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1043-1047
Number of pages5
JournalThe journal of trauma and acute care surgery
Volume85
Issue number6
DOIs
StatePublished - Dec 1 2018

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Abdomen
Emergencies
Wounds and Injuries
Ventilator-Associated Pneumonia
Mechanical Ventilators
Abdominal Wound Closure Techniques
Artificial Respiration

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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Trauma and emergency general surgery patients should be extubated with an open abdomen. / Taveras, Luis R.; Imran, Jonathan B.; Cunningham, Holly B.; Madni, Tarik D.; Taarea, Roberto; Tompeck, Allison; Clark, Audra T.; Provenzale, Natalie; Adeyemi, Folarin M.; Minshall, Christian T; Eastman, Alexander; Cripps, Michael W.

In: The journal of trauma and acute care surgery, Vol. 85, No. 6, 01.12.2018, p. 1043-1047.

Research output: Contribution to journalArticle

Taveras, LR, Imran, JB, Cunningham, HB, Madni, TD, Taarea, R, Tompeck, A, Clark, AT, Provenzale, N, Adeyemi, FM, Minshall, CT, Eastman, A & Cripps, MW 2018, 'Trauma and emergency general surgery patients should be extubated with an open abdomen', The journal of trauma and acute care surgery, vol. 85, no. 6, pp. 1043-1047. https://doi.org/10.1097/TA.0000000000002064
Taveras, Luis R. ; Imran, Jonathan B. ; Cunningham, Holly B. ; Madni, Tarik D. ; Taarea, Roberto ; Tompeck, Allison ; Clark, Audra T. ; Provenzale, Natalie ; Adeyemi, Folarin M. ; Minshall, Christian T ; Eastman, Alexander ; Cripps, Michael W. / Trauma and emergency general surgery patients should be extubated with an open abdomen. In: The journal of trauma and acute care surgery. 2018 ; Vol. 85, No. 6. pp. 1043-1047.
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abstract = "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.",
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T1 - Trauma and emergency general surgery patients should be extubated with an open abdomen

AU - Taveras, Luis R.

AU - Imran, Jonathan B.

AU - Cunningham, Holly B.

AU - Madni, Tarik D.

AU - Taarea, Roberto

AU - Tompeck, Allison

AU - Clark, Audra T.

AU - Provenzale, Natalie

AU - Adeyemi, Folarin M.

AU - Minshall, Christian T

AU - Eastman, Alexander

AU - Cripps, Michael W

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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.

AB - 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.

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