TAILIEUCHUNG - Ebook Open abdomen - A comprehensive practical manual: Part 2

(BQ) Part 2 book “Open abdomen - A comprehensive practical manual” has contents: The role of instillation in open abdomen management, the open abdomen in infants and children, nutritional support in patients with an open abdomen, the nursing management of open abdomen patients, and other contents. | The Role of Instillation in Open Abdomen Management 11 Martin Rosenthal and Marc de Moya Key Points • Limited data to support direct peritoneal 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. Introduction The indications for open abdomen are unstable patients in shock due to trauma, abdominal sepsis, and severe acute pancreatitis and in general situations in which there is the potential for ongoing development of intra-abdominal hypertension (IAH), in order to prevent the development of abdominal compartment syndrome (ACS). Damage control surgery includes (1) controlling bleeding and contamination in the abdominal cavity and (2) leaving the abdomen open, to decompress, reevaluate, or facilitate return at planned relaparotomy. While 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 to fascial closure results in worse patient outcomes [1, 2]. Many strategies have been implemented to decrease these complications since the introduction of DCL M. Rosenthal, MD • M. de Moya, MD FACS (*) Surgical Critical Care Fellow, Massachusetts General Hospital/Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA e-mail: mrosenthal@; mdemoya@ © Springer International Publishing AG, part of Springer Nature 2018 F. Coccolini et al. (eds.), Open Abdomen, Hot Topics in Acute Care Surgery and Trauma, 135 136 M. Rosenthal and M. de Moya including conservative intravenous fluid resuscitation strategies, hypertonic saline IV resuscitation, and temporary abdominal closure (TAC) including .

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