Impact of open abdomen and Vacuum Assisted Closure Device in surgical abdominal sepsis [article]

Michael Sean Bleszynski
Surgical abdominal sepsis has traditionally been managed with by a single staged procedure, otherwise known as primary abdominal closure (PAC). An on demand laparotomy may be performed for post-operative clinical deterioration. Open abdomen and a planned re-laparotomy with vacuum assisted closure (VAC) is an alternate method to single staged procedure. Inflammatory cytokines can potentially help stratify severity of sepsis and guide surgical management. The objective of the study was to
more » ... if inflammatory cytokines could differentiate between PAC and VAC. Secondary objectives were to see if cytokines could predict mortality and characterize longitudinal cytokine profiles during open abdomen management. Severity of disease between surgical groups was compared using the Acute Physiology and Chronic Health Assessment (APACHE)-IV predictive mortality rate (PMR) calculator. Methods: Prospective case series between December 2011 to June 2013. Patients were included if they met criteria of severe abdominal sepsis/septic shock requiring urgent source control laparotomy (SCL). Blood and peritoneal samples were obtained pre- and post-operatively at primary SCL in patients who underwent PAC and VAC management. Peritoneal fluid (PF) samples were obtained once the peritoneum was entered. Blood and peritoneal samples were obtained for re-look laparotomies in the VAC group. Samples were centrifuged within 1 hour and stored at -70 degrees Celsius. Samples were analyzed with a Human Cytokine 30-plex Panel and concentrations were reported as pg/ml. Results: 12 patients were included (4 PAC and 8 VAC). PF cytokine concentrations of IL 6, IL-17, IL-5 and HGF were significantly higher in VAC compared to PAC. Peritoneal fluid at primary SCL did not differentiate between survivors and non-survivors. Pre-operative serum RANTES was significantly elevated in survivors compared to non-survivors. Pre operative serum VEGF, IL-1b, FGF-b, IL-5, IL-4, IL-7 and post-operative serum VEGF, IL-7 differentiated between VAC [...]
doi:10.14288/1.0343350 fatcat:respiabk5zcdnmtygmqblwiwrq