title: Negative-pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review.
abstract: BACKGROUND
  Open abdominal management with negative-pressure wound therapy (NPWT) is increasingly used for critically ill trauma and surgery patients. We sought to determine the comparative efficacy and safety of NPWT versus alternate temporary abdominal closure (TAC) techniques in critically ill adults with open abdominal wounds.
  
  
  METHODS
  We conducted a systematic review of published and unpublished comparative studies. We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, the Cochrane Database, the Center for Reviews and Dissemination, clinical trials registries, and bibliographies of included articles. Two authors independently abstracted data on study design, methodological quality, patient characteristics, and outcomes.
  
  
  RESULTS
  Among 2,715 citations identified, 2 randomized controlled trials and 9 cohort studies (3 prospective/6 retrospective) met inclusion criteria. Methodological quality of included prospective studies was moderate. One randomized controlled trial observed an improved fascial closure rate (relative risk [RR], 2.4; 95% confidence interval [CI], 1.0-5.3) and length of hospital stay after addition of retention sutured sequential fascial closure to the Kinetic Concepts Inc. (KCI) vacuum-assisted closure (VAC). Another reported a trend toward enhanced fascial closure using the KCI VAC versus Barker's vacuum pack (RR, 2.6; 95% CI, 0.95-7.1). A prospective cohort study observed improved mortality (RR, 0.48; 95% CI, 0.25-0.92) and fascial closure (RR, 1.5; 95% CI, 1.1-2.0) for patients who received the ABThera versus Barker's vacuum pack. Another noted a reduced arterial lactate, intra-abdominal pressure, and hospital stay for those fitted with the KCI VAC versus Bogotá bag. Most included retrospective studies exhibited low methodological quality and reported no mortality or fascial closure benefit for NPWT.
  
  
  CONCLUSIONS
  Limited prospective comparative data suggests that NPWT versus alternate TAC techniques may be linked with improved outcomes. However, the clinical heterogeneity and quality of available studies preclude definitive conclusions regarding the preferential use of NPWT over alternate TAC techniques.
  
  
  METHODS
  Systematic review, level III.
authors.affiliation: Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: David A
authors.initials: DA
authors.lastname: Zygun
authors.forename: Jan
authors.initials: J
authors.lastname: Grendar
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Helen Lee
authors.initials: HL
authors.lastname: Robertson
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Ouellet
authors.forename: Michael L
authors.initials: ML
authors.lastname: Cheatham
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000401:mortality / Q000517:prevention & control*; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*