Ebook Open abdomen - A comprehensive practical manual: Part 2
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Ebook Open abdomen - A comprehensive practical manual: Part 2
Check for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2neal resuscitation (DPR).•DPR has been shown in animal models to decrease need for intravenous crystalloid.•DPR has been suggested to improve ability to perform delayed primary closure of open abdomen.11.1IntroductionThe indications for open abdomen are unstable patients in shock due to trauma, abdo Ebook Open abdomen - A comprehensive practical manual: Part 2minal sepsis, and severe acute pancreatitis and in general situations in which there is the potential for ongoing development of intra-abdominal hyperEbook Open abdomen - A comprehensive practical manual: Part 2
tension (IAH). in order to prevent the development of abdominal compartment syndrome (ACS). Damage control surgery includes (I) controlling bleeding aCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2ile damage control laparotomy (DCL) with the accompanied open abdomen has been shown to improve survival, this comes at a cost of a host of complications including fistulae. intra-abdominal infections, and the inability to perform fascial closure. Studies have shown that a delay greater than 7 days Ebook Open abdomen - A comprehensive practical manual: Part 2to fascial closure results in worse patient outcomes (1. 2]. Many strategies have been implemented to decrease these complications since the introductEbook Open abdomen - A comprehensive practical manual: Part 2
ion of DCLM. Rosenthal, MD • M. de Moya, MD FACS (El)Surgical Critical Care Fellow. Massachusetts General Hospital/Harvard Medical School.165 CambridgCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2r Nature 2018135F. Coccolini et al. (eds.). Open Abdomen. Hot Topics in Acute Care Surgery n.1.1 Trniiminm/IA 1007/07« 1 no 1CO77 s 11136M. Rosenthal and M. de Moyaincluding conservative intravenous fluid resuscitation strategies, hypertonic saline IV resuscitation, and temporary abdominal closure ( Ebook Open abdomen - A comprehensive practical manual: Part 2TAC) including negative pressure wound therapy.Despite improvements by using these adjuncts. DCL still suffers from a less than 100% fascial closure rEbook Open abdomen - A comprehensive practical manual: Part 2
ate along with delays to successful fascial closure which leads to intra-abdominal infections, flstulae, and ventral hernias. A group from the UniversCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2rtonic fluid is administered to the open abdomen in conjunction with negative pressure wound therapy to counteract the effects of shock. Their work has shown an increase in the rate of delayed primary fascial closure, a decreased time to fascial closure, as well as reduced intra-abdominal complicati Ebook Open abdomen - A comprehensive practical manual: Part 2ons [2-4]. DPR appears to improve outcomes by splanchnic vasodilation reducing organ ischemia. This also effectively reduces organ edema as well as thEbook Open abdomen - A comprehensive practical manual: Part 2
e pro-inflammatory cytokine cascade. In animal shock models, they were able to show a reduction in mortality from 40% to 0% [2, 3. 5]. Specific findinCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2 the open abdomen, i.e.. lateral wall retraction, there are other physiologic factors that can lead to inability to close the abdomen and/or worsening inflammatory response. Trauma patients in hemorrhagic shock are often aggressively resuscitated with IV crystalloid fluid and blood products to maint Ebook Open abdomen - A comprehensive practical manual: Part 2ain intravascular volume and restore normal hemodynamics. Unfortunately, measurements of blood pressure, heart rate, urine output, and central venousEbook Open abdomen - A comprehensive practical manual: Part 2
pressure used commonly as clinical endpoints of adequate resuscitation are inadequate indicators of tissue perfusion [6. 7]. Thus, conventional IV resCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2re. This can be attributed to three major pathophysiologic events, progressive splanchnic vasoconstriction and hypoperfusion, gut-derived exaggerated systemic inflammatory response, and obligatory tissue fluid sequestration [3. 8. 9].During shock the body experiences a profound vasoconstriction of b Ebook Open abdomen - A comprehensive practical manual: Part 2oth the pulmonary and systemic circulation. Even after normalization of hemodynamics, the vasoconstriction resolves slowly. The visceral organs such aEbook Open abdomen - A comprehensive practical manual: Part 2
s the small intestine and the liver are particularly prone to prolonged ischemia. When these organs are reperfused. they create a severe and prolongedCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 211 The Role of Instillation in open Abdomen Management13711.3Direct Peritoneal ResuscitationDPR involves bathing the abdominal contents with a dextrose-based, vasoactive, topical, hypertonic, dialysate solution (Delflex. Fresenius Medical Care). The technique is described by Zakaria. Garrison et al. Ebook Open abdomen - A comprehensive practical manual: Part 2 in which after DCL the abdomen is prepared for temporary abdominal closure [3]. A 19Fr silicone drain is placed in the left upper lateral quadrant anEbook Open abdomen - A comprehensive practical manual: Part 2
d directed around the root of the mesentery along the left paracolic gutter and down into the pelvis. A temporary abdominal closure is prepared with sCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2 11.1). The abdomen is than lavaged with Delflcx. starting with a 800-1000 mL bolus through the left upper quadrant drain, followed by a continuous infusion of 400 mL/h until repeat laparotomy. The dialysate fluid is continuously suctioned through the superficial drains, and IV resuscitation is give Ebook Open abdomen - A comprehensive practical manual: Part 2n concomitantly [3].SuctionY-connectorloban over chest tubesBlue towels under chest tubesFig. 11.1 Model of direct peritoneal resuscitation. ReprintedEbook Open abdomen - A comprehensive practical manual: Part 2
with permission from Weaver et al. 11()|2.5% PD solutionIS*3 tubing138M. Rosenthal and M. de Moya11.3.1Animal StudiesIn previous microcirculatory stuCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2triction, and restore intestinal blood How above baseline [2. 6. 7. 9. I0J. Illis led to further studies on whole animals in a hemorrhagic shock model where rals were exposed lo isotonic saline versus Dclflcx abdominal lavage after being bled to shock levels, They were able to demonstrate that the s Ebook Open abdomen - A comprehensive practical manual: Part 2uffusion of a 2.5% glucose-based peritoneal dialysis solution (Dclflcx) concurrent with intravenous resuscitation from hemorrhagic shock causes microvEbook Open abdomen - A comprehensive practical manual: Part 2
ascular vasodilation and increases visceral and hepatic blood How. reverses endothelial cell dysfunction, improves survival and downregulates the inflCheck for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct periton Ebook Open abdomen - A comprehensive practical manual: Part 2 |6J. In addition they noted a marked ability to decrease visceral edema and normalize body waler ratios [51. Dclflex DPR leads to these physiologic changes without a systemic change in mean arterial pressure [9J.11.3.2Human Studies Ebook Open abdomen - A comprehensive practical manual: Part 2Check for bpdateeThe Role of Instillation in Open Abdomen ManagementMartin Rosenthal and Marc de MoyaKey Points•Limited data to support direct peritonGọi ngay
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