title: Damage Control and the Open Abdomen: Challenges for the Nonsurgical Intensivist.
abstract: BACKGROUND
  As strategies in acute care surgery focus on damage control to restore physiology, intensivists spanning all disciplines care for an increasing number of patients requiring massive transfusion, temporary abdominal closures, and their sequelae.
  
  
  OBJECTIVE
  To equip the nonsurgical intensivist with evidence-based management principles for patients with an open abdomen after damage control surgery.
  
  
  METHODS
  Search of PubMed database and manual review of bibliographies from selected articles.
  
  
  CONCLUSIONS
  Temporary abdominal closure improves outcomes in patients with abdominal compartment syndrome, hemorrhagic shock, and intra-abdominal sepsis but creates new challenges with electrolyte derangement, hypovolemia, malnutrition, enteric fistulas, and loss of abdominal wall domain. Intensive care of such patients mandates attention to resuscitation, sepsis control, and expedient abdominal closure.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA cgriggs@partners.org.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Griggs
authors.affiliation: Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Butler
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001803:Blood Transfusion / Q000379:methods*; D003422:Critical Care; D055416:Evidence-Based Emergency Medicine; D000071938:Fasciotomy / Q000379:methods*; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012771:Shock, Hemorrhagic / Q000000981:diagnostic imaging / Q000628:therapy*; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: abdominal compartment syndrome; damage control surgery; enteroatmospheric fistula; open abdomen