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Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen:a randomized controlled trial

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Military Medical Research 2022年第2期9卷 193-204页

作者： Kai Wang Shi-Long Sun Xin-Yu Wang Cheng-Nan Chu Ze-Hua Duan Chao Yang Bao-Chen Liu Wei-Wei Ding Wei-Qin Li Jie-Shou Li Division of Trauma and Surgical Intensive Care Unit Research Institute of General SurgeryJinling HospitalMedical School of Nanjing UniversityNo.305 East Zhongshan RoadNanjing 210002China Division of Trauma and Surgical Intensive Care Unit Research Institute of General Surgerythe First School of Clinical MedicineSouthern Medical UniversityNanjing 210002China

Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)*** impedance analysis(BIA)is a promising tool for monitoring fluid status and ***,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA ***:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)*** primary outcome was the 30-day primary fascial closure(PFC)*** secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after *** Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was ***:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,P<0.001).In the BIA group,the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d(P<0.001).Additionally,the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml(P<0.001)and fewer ***:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complicat

关键词： Trauma open abdomen Fluid overload Fluid resuscitation Primary fascial closure Bioelectrical impedance analysis

Establishment and evaluation of an improved rat model of open abdomen

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Animal Models and Experimental Medicine 2024年第4期7卷 562-569页

作者： Ye Liu Sicheng Li Jinjian Huang Ze Li Kang Chen Guiwen Qu Xiuwen Wu Jianan Ren School of Medicine Southeast UniversityNanjingChina Research Institute of General Surgery Affiliated Jinling HospitalMedical School of Nanjing UniversityNanjingChina

Introduction:This study aimed to establish an animal model of open abdomen(OA)through temporary abdominal closure via different ***:Adult male Sprague-Dawley rats were randomly divided into three groups:group A(OA with polypropylene mesh alone);group B(OA with polypro-pylene mesh combined with a patch);and group C(OA with polypropylene mesh and a sutured patch).Vital signs,pathophysiological changes,and survival rates were closely monitored in the rats for 7 days after *** X-rays and histopathological examinations were performed to assess abdominal organ changes and wound ***:The results showed no significant difference in mortality rates among the three groups(p>0.05).However,rats in group B exhibited superior overall condi-tion,cleaner wounds,and a higher rate of wound healing compared to the other groups(p<0.05).Abdominal X-rays indicated that varying degrees of distal intestinal obstruction in all *** examinations revealed fibrous hyperpla-sia,inflammatory cell infiltration,neovascularization,and collagen deposition in all *** B demonstrated enhanced granulation tissue generation,neovasculari-zation,and collagen deposition compared to the other groups(p<0.05).Conclusions:Polypropylene mesh combined with patches is the most suitable method for establishing an animal model of *** model successfully replicated the patho-logical and physiological changes in postoperative patients with OA,specifically the progress of abdominal skin wound *** provides a practical and reliable animal model for OA research.

关键词： animal models open abdomen patch polypropylene mesh

Multiple portions enteral nutrition and chyme reinfusion of a blunt bowel injury patient with hyperbilirubinemia undergoing open abdomen:A case report

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Chinese Journal of Traumatology 2023年第4期26卷 236-243页

作者： Kai Wang Yun-Xuan Deng Kai-Wei Li Xin-Yu Wang Chao Yang Wei-Wei Ding Division of Trauma and Surgical Intensive Care Unit Research Insttute of General SurgeryAffliated jinling HospitalMedical Schoolof Nanjing UniversityNanjing20002China The First School of Clinical Medicine Southern Medical UniversityNanjing210002China

Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or *** enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the ***,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day *** exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was ***,the patient was transferred to our trauma center for septic shock and *** salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was *** the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding ***,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding *** was alleviated with the increase in chyme *** 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular *** BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.

关键词： Blunt bowel injury open abdomen Enteral nutrition Chyme reinfusion Hyperbilirubinemia Case report

3D-printed “fistula stent” designed for management of enterocutaneous fistula: An advanced strategy

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World Journal of Gastroenterology 2017年第41期23卷 7489-7494页

作者： Jin-Jian Huang Jian-An Ren Ge-Fei Wang Zong-An Li Xiu-Wen Wu Hua-Jian Ren Song Liu Department of Surgery Jinling Hospital School of Medicine Southeast University NARI School of Electrical and Automation Engineering Nanjing Normal University Department of General Surgery Nanjing Drum Tower Hospital

Enterocutaneous fistulas(ECFs) are great challenges during the open abdomen. The loss of digestive juice, water-electrolyte imbalance and malnutrition are intractable issues during management of ECF. Techniques such as "fistula patch" and vacuumassisted closure therapy have been applied to prevent contamination of open abdominal wounds by intestinal fistula drainage. However, failures are encountered due to high-output fistula and anatomical complexity. Here, we report 3 D-printed patient-personalized fistula stent for ECF treatment based on 3 D reconstruction of the fistula image. Subsequent follow-up demonstrated that this stent was well-implanted and effective to reduce the volume of enteric fistula effluent.

关键词： Enterocutaneous fistula 3D printing open abdomen Isolation technique

Topical negative pressure in managing severe peritonitis: A positive contribution?

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World Journal of Gastroenterology 2009年第27期15卷 3394-3397页

作者： Amin Ibrahim Amin Irshad A Shaikh Consultant surgeon Queen Margaret hospitalDunfermline Scotland KY12 0SU United Kingdom Specialist Registrar Royal Infirmary of EdinburghLittle France Edinburgh Scotland EH16 4SAUnited Kingdom

AIM： To assess the use of topical negative pressure （TNP） in the management of severe peritonitis. METHODS： This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP following laparotomy for severe peritonitis. RESULTS： There were 11 males with an average age of （59.3 ± 3.95） years. Nine had a perforated viscus, five had anastomotic leaks, three had iatrogenic bowel injury, and a further three had severe pelvic inflammatory disease. TNP and the VAC Abdominal Dressing System were initially used. These were changed every two to three days. Abdominal closure was achieved in 15/20 patients within 4.53 ± 1.64 d. One patient required relaparotomy due to residual sepsis. Two patients with severe faecal peritonitis due to perforated diverticular disease received primary anastomosis at second look laparotomy, as sepsis and their general condition improved. In the remaining 5/20 cases, the abdomen was lee open due to bowel oedema and or abdominal wall oedema. Dressing was switched to TNP and VAC GranuFoam . Three of the five patients returned a few months later for abdominal wall reconstruction and restoration of intestinal continuity. Two patients developed intestinal fistulae. All 20 patients survived.CONCLUSION： The use of TNP is safe. Further studies are needed to assess its value in managing these difficult cases.

关键词： Severe peritonitis open abdomen Topicalnegative pressure VAC Abdominal Dressing System VAC GranuFoam

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

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World Journal of Gastroenterology 2020年第3期26卷 266-278页

作者： Venkat Rajasurya Salim Surani Department of Pulmonary and Critical Care Novant Health SystemWinston-SalemNC 27103United States Department of Pulmonary Critical Care and Sleep Medicine Texas A&M Health Science CenterBryanTX 77807United States

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical ***,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for *** is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and *** it is underdiagnosed and undertreated in this patient *** intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic *** intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and *** volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal *** article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

关键词： Intra-abdominal pressure Intra-abdominal hypertension Abdominal compartment syndrome Acute kidney injury Large volume resuscitation open abdomen Bladder pressure Medical intensive care unit

Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature

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World Journal of Clinical Cases 2023年第4期11卷 852-858页

作者： He-Yun Li Zhi-Xiang Wang Jian-Chun Wang Xiao-Di Zhang Department of Intensive Care Unit Shaanxi Nuclear Industry 215 HospitalXianyang 712000Shaanxi ProvinceChina Department of General Surgery Shaanxi Nuclear Industry 215 HospitalXianyang 712000Shaanxi ProvinceChina Department of Healthcare-associate Infection Management Shaanxi Nuclear Industry 215 HospitalXianyang 712000Shaanxi ProvinceChina

BACKGROUND Abdominal Clostridium perfringens(C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by *** infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal *** SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation,we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were *** consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to GuillainBarre syndrome 75 d after the first surgery. This paper presents this case of intraabdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current *** When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage,appropriate antibiotic therapy, and intensiv

关键词： Clostridium perfringens Intra-abdominal infection Gas gangrene open abdomen Case report

Reimagining the Visceral Protective Layer with Tailored Manipulation: A Case Report

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Surgical Science 2022年第2期13卷 53-65页

作者： R. Dewayne Edwards Luis G. Fernandez Sean O’Keefe Michelle Baribault Marc R. Matthews Burn Surgery and Surgical Critical Care The Arizona Burn Center Phoenix AZ USA Department of Surgery University of Texas Health Science Center Tyler TX USA 3M Phoenix AZ USA Mountain Vista Medical Center Mesa AZ USA The Arizona Burn Center Phoenix AZ USA

The visceral protective layer is a standard component of the ABTHERATM systems for temporary abdominal closures. Nonetheless, there are circumstances where the standard, fenestrated visceral protective layer is too large to be successfully applied into every patient’s open abdomen, such as within the abdomen of a child, smaller adult or a patient with previously placed ostomies or drains. The fenestrated, visceral protective layer may require alterations or tailoring for adequate deployment instead of placing the bulk of the visceral protective layer entirely into the open abdomen for temporary abdominal closure. This case report illustrates how the visceral protective layer can be adapted or “reimagined” to conform to a patient with unique or complex abdominal domain features when utilizing the ABTHERATM device prior to facial closure or abdominal wall reconstruction. Photographs are utilized in a step-by-step fashion to aid the clinician in these detailed maneuvers.

关键词： open abdomen Temporary Abdominal Closure Visceral Protective Layer Loss of Abdominal Domain

Current progress of source control in the management of intra-abdominal infections

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Chinese Journal of Traumatology 2020年第6期23卷 311-313页

作者： Xiu-Wen Wu Tao Zheng Zhi-Wu Hong Hua-Jian Ren Lei Wu Ge-Fei Wang Guo-Sheng Gu Jian-An Ren Research Institute of General Surgery Jinling HospitalMedical School of Nanjing UniversityNanjingChina Lab for Trauma and Surgical Infection Jinling HospitalNanjingChina

Intra-abdominal infection(IAI)is a deadly condition in which the outcome is associated with urgent diagnosis,assessment and management,including fluid resuscitation,antibiotic administration while obtaining further laboratory results,attaining precise measurements of hemodynamic status,and pursuing source *** last item makes abdominal sepsis a unique treatment *** or inadequate source control is an independent predictor of poor outcomes and recognizing source control failure is often difficult or *** complicating issue in the debate is surrounding the timing,adequacy,and procedures of source *** review evaluated and summarized the current approach and challenges in IAI management,which are the future research directions.

关键词： Source control Intra-abdominal infection open abdomen Source control failure