Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection
Table 1
The recognized indications for the open abdomen treatment.
Indication
Specific situation vignettes
IAI
(1) Source control unsatisfied; (2) SIRS or sepsis predicted; (3) hypovolemic shock resulted from complicated fluid loss or hemorrhage unavoidable; (4) immunocompromised status presented.
DCS for severe trauma
(1) Death triangle (hypothermia <35°C, severe acidosis with base deficit >15 mmol/L, and coagulopathy) emerged; (2) the abdomen cannot be closed primarily due to extensive abdominal wall defection; (3) life-threatening intra-abdominal bleeding suspected or confirmed; (4) interventional therapy for hemostasis failed.
Persistent IAH/ACS
(1) IAP by bladder pressure measurements >20 mmHg more than 48 h; (2) sustained IAP >20 mmHg (with/without an abdominal perfusion pressure <60 mmHg) and at least one organ dysfunction present, in particular for kidney dysfunction. (3) Pulmonary and cardiac function declined significantly; (4) other decompression measures (percutaneous drainage, diuresis, etc.) unsatisfied.
Acute mesenteric ischemia
(1) The need for a mandatory “second look” to evaluate bowel viability and resect additional ischemic bowel segments if necessary; (2) persistent IAH developed, complying with ileus or intestinal necrosis.
Necrotizing infection of the abdominal wall
(1) The infection mainly originated from the endogenous microflora, frequently associated with complications of initial laparotomy; (2) bacterial translocation can be predicted through clinical indexes; (3) necrotizing tissues cannot be repaired from conventional therapies; (4) complicated compartment syndrome occurred.
