Surveyed opinion of american trauma surgeons on the prevention of the abdominal compartment syndrome

John C. Mayberry, Robert K. Goldman, Richard Mullins, Dawn M. Brand, Richard A. Crass, Donald Trunkey

    Research output: Contribution to journalArticle

    95 Citations (Scopus)

    Abstract

    Objective: To determine the current opinion of American trauma surgeons on the use of the open abdomen to prevent the abdominal compartment syndrome (ACS). Methods: On a questionnaire survey of expert trauma surgeons regarding 12 clinical factors influencing fascial closure at trauma celiotomy, surgeons graded their willingness to close the fascia in various scenarios on a scale of 1 to 5. The impact of six signs of clinical deterioration on willingness to perform abdominal decompression in a patient with postceliotomy elevated intra-abdominal pressure (IAP) was also queried. Of 292 members of the American Association for the Surgery of Trauma active in abdominal trauma management, 248 members (85%) had experience with ACS one or more times in the previous year. Results: Surgeons' responses to factors found at trauma celiotomy were divided into two distinct categories: factors decreasing willingness to close the fascia, and factors not changing or increasing willingness to close the fascia (p <0.001). Factors disfavoring fascial closure were pulmonary or hemodynamic deterioration with closure, massive bowel edema, subjectively tight closure, planned reoperation, and packing. Factors not changing or favoring fascial closure were fecal contamination/peritonitis, massive transfusion, hypothermia, multiple abdominal injuries, acidosis, and coagulopathy. Five of the six signs of clinical deterioration increased surgeons' willingness to decompress a patient with elevated IAP (increased O2 requirement, decreased cardiac output, increased acidosis, increased airway pressures, and oliguria). Lowered gastric mucosal pH did not affect willingness. Seventy-one percent of surgeons indicated they would decompress elevated IAP in postceliotomy patient if one or two signs of clinical deterioration were present, but only 14% would decompress a patient for elevated IAP alone. Conclusion: A majority of expert American trauma surgeons have experience with ACS and would leave the abdomen open if ACS occurred. A majority would reopen a closed abdomen in cases of elevated IAP with signs of clinical deterioration. A minority would leave the abdomen open when there was only a risk of developing ACS.

    Original languageEnglish (US)
    Pages (from-to)509-514
    Number of pages6
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume47
    Issue number3
    DOIs
    StatePublished - Sep 1999

    Fingerprint

    Intra-Abdominal Hypertension
    Pressure
    Wounds and Injuries
    Abdomen
    Fascia
    Acidosis
    Lower Body Negative Pressure
    Oliguria
    Abdominal Injuries
    Multiple Trauma
    Surgeons
    Hypothermia
    Peritonitis
    Reoperation
    Cardiac Output
    Edema
    Stomach
    Hemodynamics
    Lung

    Keywords

    • Abdominal compartment syndrome
    • Abdominal trauma
    • Intra-abdominal pressure
    • Survey

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Surveyed opinion of american trauma surgeons on the prevention of the abdominal compartment syndrome. / Mayberry, John C.; Goldman, Robert K.; Mullins, Richard; Brand, Dawn M.; Crass, Richard A.; Trunkey, Donald.

    In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 47, No. 3, 09.1999, p. 509-514.

    Research output: Contribution to journalArticle

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    abstract = "Objective: To determine the current opinion of American trauma surgeons on the use of the open abdomen to prevent the abdominal compartment syndrome (ACS). Methods: On a questionnaire survey of expert trauma surgeons regarding 12 clinical factors influencing fascial closure at trauma celiotomy, surgeons graded their willingness to close the fascia in various scenarios on a scale of 1 to 5. The impact of six signs of clinical deterioration on willingness to perform abdominal decompression in a patient with postceliotomy elevated intra-abdominal pressure (IAP) was also queried. Of 292 members of the American Association for the Surgery of Trauma active in abdominal trauma management, 248 members (85{\%}) had experience with ACS one or more times in the previous year. Results: Surgeons' responses to factors found at trauma celiotomy were divided into two distinct categories: factors decreasing willingness to close the fascia, and factors not changing or increasing willingness to close the fascia (p <0.001). Factors disfavoring fascial closure were pulmonary or hemodynamic deterioration with closure, massive bowel edema, subjectively tight closure, planned reoperation, and packing. Factors not changing or favoring fascial closure were fecal contamination/peritonitis, massive transfusion, hypothermia, multiple abdominal injuries, acidosis, and coagulopathy. Five of the six signs of clinical deterioration increased surgeons' willingness to decompress a patient with elevated IAP (increased O2 requirement, decreased cardiac output, increased acidosis, increased airway pressures, and oliguria). Lowered gastric mucosal pH did not affect willingness. Seventy-one percent of surgeons indicated they would decompress elevated IAP in postceliotomy patient if one or two signs of clinical deterioration were present, but only 14{\%} would decompress a patient for elevated IAP alone. Conclusion: A majority of expert American trauma surgeons have experience with ACS and would leave the abdomen open if ACS occurred. A majority would reopen a closed abdomen in cases of elevated IAP with signs of clinical deterioration. A minority would leave the abdomen open when there was only a risk of developing ACS.",
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    AU - Crass, Richard A.

    AU - Trunkey, Donald

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