Chasing 100%: the use of hypertonic saline to improve early, primary fascial closure after damage control laparotomy.
BACKGROUND
Failure to achieve fascial closure after damage control laparotomy (DCL) is associated with increased morbidity and long-term disability. In addition, early closure is associated with reduces infectious, wound, and pulmonary complications. We hypothesized that hypertonic saline (HTS), which attenuates resuscitation-induced intestinal edema in animals, would improve early primary fascial closure (EPFC) rates.


METHODS
This is a retrospective study of trauma patients undergoing DCL, from January 2010 to July 2011. Patients in the HTS group had 30 mL/h of 3% sodium chloride as maintenance fluids while the fascia was open. Patients in the cohort group had isotonic fluids (125 mL/h). The primary outcome, EPFC, was defined as primary fascial closure by postinjury day 7.


RESULTS
Seventy-seven patients underwent DCL (23 received HTS and 54 received isotonic fluids). There were no differences in demographics, injury severity, or pre-intensive care unit vitals, laboratories, fluids, or transfusions. Median fluids in the first 24 hours were lower in the HTS group (3.9 vs. 7.8 L, p < 0.001). Times to fascial closure were shorter in those receiving HTS (34 vs. 49 hours, p < 0.001), as were the rates of closure at first take back (78% vs. 53%, p = 0.036). The primary outcome of EPFC was higher in the HTS group compared with standard fluids (100% vs. 76%, p = 0.010). At discharge, the HTS group had a 96% primary fascial closure rate compared with 80% with standard fluids.


CONCLUSIONS
The use of 3% HTS as maintenance fluids after DCL was associated with 100% EPFC. HTS may be used as an adjunct to facilitate fascial closure in patients undergoing DCL.


METHODS
Diagnostic study, level III.
Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA.
John A
JA
Harvin
Mark M
MM
Mims
Juan C
JC
Duchesne
Charles S
CS
Cox
Charles E
CE
Wade
John B
JB
Holcomb
Bryan A
BA
Cotton
D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic