Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures

Abstract

Introduction: Critically ill surgical patients frequently develop intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) with subsequent high mortality. We compared two temporary abdominal closure systems (Bogota bag and vacuum-assisted closure (VAC) device) in intra-abdominal pressure (IAP) control.

Methods: This prospective study with a historical control included 66 patients admitted to a medical and surgical intensive care unit (ICU) of a tertiary care referral center (Careggi Hospital, Florence, Italy) from January 2006 to April 2009. The control group included patients consecutively treated with the Bogota bag (Jan 2006-Oct 2007), whereas the prospective group was comprised of patients treated with a VAC. All patients underwent abdominal decompressive surgery. Groups were compared based upon their IAP, SOFA score, serial arterial lactates, the duration of having their abdomen open, the need for mechanical ventilation (MV) along with length of ICU and hospital stay and mortality. Data were collected from the time of abdominal decompression until the end of pressure monitoring.

Results: The Bogota and VAC groups were similar with regards to demography, admission diagnosis, severity of illness, and IAH grading. The VAC system was more effective in controlling IAP (P < 0.01) and normalizing serum lactates (P < 0.001) as compared to the Bogota bag during the first 24 hours after surgical decompression. There was no significant difference between the SOFA scores. When compared to the Bogota, the VAC group had a faster abdominal closure time (4.4 vs 6.6 days, P = 0.025), shorter duration of MV (7.1 vs 9.9 days, P = 0.039), decreased ICU length of stay (LOS) (13.3 vs 19.2 days, P = 0.024) and hospital LOS (28.5 vs 34.9 days; P = 0.019). Mortality rate did not differ significantly between the two groups.

Conclusions: Patients with abdominal compartment syndrome who were treated with VAC decompression had a faster abdominal closure rate and earlier discharge from the ICU as compared to similar patients treated with the Bogota bag.

Figure 1

Comparison of (a) IAP, (b) SOFA score, and (c) arterial lactates between patients treated with Bogota bag (Bogota group) and patients treated with VAC device (VAC group). Data are represented as mean ± standard deviation. Statistical analysis was a two-tailed Mann-Whitney test. *P < 0.01; **P < 0.001. IAP = intraabdominal pressure; SOFA = Sequential Organ Failure Assessment; T0 = before surgical treatment; T1-24 = first day (collected every four hours) after surgical treatment; T24C = 24 hours after abdomen closure; TMS = at monitoring suspension; VAC = vacuum-assisted closure.

Figure 2

Daily IAP evolution during the first seven days after decompression in Bogota group and VAC group. Data represent mean ± standard deviation. Grey arrows: median/mean time of abdominal closure in Bogota group. Black arrows: median/mean time of abdominal closure in vacuum-assisted closure (VAC) group. IAP = intraabdominal pressure.