Use of Hypertonic Saline After Damage Control Laparotomy to Improve Early Primary Fascial Closure

reportActive / Technical Report | Accesssion Number: AD1223346 | Open PDF

Abstract:

The inability to close the abdominal wall following an initial damage control laparotomy (DCL) has led to new challenges. Purpose: This project aims to test hypertonic saline (HTS) use after DCL to reduce bowel edema and resuscitation volume, leading to successful and faster primary fascial closure (PFC). Our primary objective is to determine if there is a higher rate of PFC in patients who undergo DCL when using HTS versus crystalloid resuscitation. Method: The protocol design was a multi-institutional (5 sites), prospective, double-blind, randomized controlled trial of 195 patients who underwent DCL for abdominal trauma requiring temporary abdominal closure and return to the operating room for definitive treatment. All facilities were Level I Trauma Centers. Results: There were no differences in rates of primary facial closure between the two groups or for time in hours until closure. The HTS group had less fluids daily over 72 hours and over the 72-hour period. The complication rate was higher in all categories except abdominal compartment syndrome in the normal saline group. Mortality in the normal saline group was double that of the HTS group. Finally, coagulation, pH, and lactate did not significantly differ between the two groups throughout the 72-hour evaluation. Conclusion: Finally, our results found an increase in inflammatory markers with the HTS cohort that does not support previously published studies, demonstrating the incompletely understood interaction between trauma and inflammation, as well as the interplay of HTS. This analysis was part of the larger multicenter trial investigating infection rates and organ dysfunction and may necessitate more extensive studies investigating the effects of inflammatory cytokine levels on trauma patient outcomes.

Security Markings

DOCUMENT & CONTEXTUAL SUMMARY

Distribution Code:
A - Approved For Public Release
Distribution Statement: Public Release.
Copyright: Not Copyrighted

RECORD

Collection: TRECMS
Subject Terms