Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory physiology.
This study prospectively analyzed outcomes in 49 consecutive patients undergoing temporary abdominal closure (TAC) between 1993 and 1996 at a single university hospital. There were 37 males and 12 females, mean age was 57 years (range, 25-79 years), mean Acute Physiology and Chronic Health Evaluation score was 27 (+7.8 SD), and mean Simplified Acute Physiology II score was 53.0 (+/-15.4). The reason for TAC was decompression in 22 patients, inability to close the abdomen in 10 patients, to facilitate reexploration for sepsis in 8 patients, and multifactorial in 9 patients. After TAC, there was a significant reduction in intra-abdominal pressure from 24.2+/-9.3 to 14.1+/-5.5 mm Hg and improvement in lung dynamic compliance from 24.1+/-7.9 to 27.6+/-9.4 mL/cm H2O (p < 0.05). Although 10 patients experienced brisk diuresis, there was no significant improvement in renal function; in fact, serum creatinine increased. The median length of stay was 35 days (range, 1-232 days). The mean number of abdominal operations after mesh insertion was 2.6+/-2.4. There were 21 deaths, for a standardized mortality rate of 0.80. Although it achieved significant reductions in abdominal pressures and improved lung dynamic compliance, TAC did not result in improved renal function or patient oxygenation.
Sugrue
M
M
Department of Surgery, Liverpool Hospital, Sydney, Australia. m.sugrue@unsw.edu.au
Jones
F
F
Janjua
K J
KJ
Deane
S A
SA
Bristow
P
P
Hillman
K
K
D018806:APACHE; D000005:Abdomen / Q000502:physiology*; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008170:Lung Compliance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011095:Polyethylenes / Q000627:therapeutic use*; D011126:Polypropylenes / Q000627:therapeutic use*; D011312:Pressure; D011446:Prospective Studies; D012119:Respiration
C016674:Plastipore; D011095:Polyethylenes; D011126:Polypropylenes; D003404:Creatinine