Surveyed opinion of American trauma surgeons on the prevention of the abdominal compartment syndrome

Objective: To determine the current opinion of American trauma surgeons on the use of the open abdomen to prevent the abdominal compartment syndrome ( ACS). Methods: On a questionnaire survey of expert trauma surgeons regarding 12 c linical factors influencing fascial closure at trauma celiotomy, surgeons g raded their willingness to close the fascia in various scenarios on a scale of 1 to ts, The impact of six signs of clinical deterioration on willingne ss to perform abdominal decompression in a patient with postceliotomy eleva ted intra-abdominal pressure (IAP) was also queried, Of 292 members of the American Association for the Surgery of Trauma active in abdominal trauma m anagement, 248 members (85%) had experience with ACS one or more times in t he previous gear. Results: Surgeons' responses to factors found at trauma celiotomy were divi ded into two distinct categories: factors decreasing willingness to close t he fascia, and factors not changing or increasing willingness to close the fascia (p < 0.001), Factors disfavoring fascial closure were pulmonary or h emodynamic deterioration with closure, massive bowel edema, subjectively ti ght closure, planned reoperation, and packing. Factors not changing or favo ring fascial closure were fecal contamination/peritonitis, massive transfus ion, hypothermia, multiple abdominal injuries, acidosis, and coagulopathy. Five of the six signs of clinical deterioration increased surgeons' willing ness to decompress a patient with elevated IAP (increased 0, requirement, d ecreased cardiac output, increased acidosis, increased airway pressures? an d oliguria), Lowered gastric mucosal pH did not affect willingness. Seventy -one percent of surgeons indicated they mould decompress elevated IAP in po stceliotomy patient if one or two signs of clinical deterioration were pres ent, but only 14% would decompress a patient for elevated IAP alone. Conclusion: A majority of expert American trauma surgeons have experience w ith ACS and would leave the abdomen open if ACS occurred. A majority would reopen a closed abdomen in cases of elevated WP with signs of clinical dete rioration. A minority would leave the abdomen open when there was only a ri sk of developing ACS.