title: Goal directed fluid resuscitation decreases time for lactate clearance and facilitates early fascial closure in damage control surgery.
abstract: BACKGROUND
  Damage-control surgery frequently results in open abdomen. The objective of this study was to determine whether resuscitation with goal-directed fluid therapy (GDT) using "dynamic" hemodynamic indices via modern pulse contour analysis devices such as the FloTrac Vigileo monitor leads to lower fluid requirements, subsequent quicker abdominal closure, and overall improved outcomes in these patients.
  
  
  METHODS
  Patients admitted to the surgical intensive care unit with open abdomen were retrospectively reviewed. Those resuscitated with Vigileo-guided GDT were matched to those resuscitated by static clinical parameters.
  
  
  RESULTS
  Total fluid intake and vasopressor requirements were similar in both groups. GDT with the Vigileo allowed earlier lactate clearance and reduced the number of days until abdominal wall closure by an average of .99 days.
  
  
  CONCLUSIONS
  Vigileo-mediated GDT did not affect fluid volume or vasopressor use in open abdomen patients, but facilitated more effective resuscitation and decreased the number of days to fascial closure, leading to shorter hospital stays. Vigileo-mediated GDT, therefore, may improve overall outcomes in open abdomen patients.
authors.affiliation: General Surgery Department, Scott & White Healthcare/Texas A&M Health Science Center College of Medicine, 2401 South 31st Street, Temple, TX 56708, USA.
authors.forename: Mira H
authors.initials: MH
authors.lastname: Ghneim
authors.forename: Justin L
authors.initials: JL
authors.lastname: Regner
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Jupiter
authors.forename: Francis
authors.initials: F
authors.lastname: Kang
authors.forename: Gwen L
authors.initials: GL
authors.lastname: Bonner
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Bready
authors.forename: Richard
authors.initials: R
authors.lastname: Frazee
authors.forename: David
authors.initials: D
authors.lastname: Ciceri
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Davis
mesh_terms: D000007:Abdominal Injuries / Q000097:blood / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019344:Lactic Acid
keywords: Damage control surgery; Early abdominal wall closure; Early lactate clearance; Goal-directed therapy; Open abdomen; Vigileo