Evidence map›Paper›PMID 37773464›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2024

The impact of hypertonic saline on damage control laparotomy after penetrating abdominal trauma.

Lee Schmidt, Lillian Kang, Taylor Hudson, Patricia Martinez Quinones, Kathleen Hirsch, Kristen DiFiore, Krista Haines, Lewis J Kaplan, Joseph S Fernandez-Moure

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Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1 · What the graph read from it

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1 citing paper in PubMed.

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5 · Who and what money

Authors and funding

9 authors.

Lee SchmidtDepartment of Surgery, Division of Trauma, Acute and Critical Care Surgery, Duke University School of Medicine, Durham, NC, USA.
Lillian KangDepartment of Surgery, Division of Trauma, Acute and Critical Care Surgery, Duke University School of Medicine, Durham, NC, USA.
Taylor HudsonDepartment of Surgery, Division of Trauma, Acute and Critical Care Surgery, Duke University School of Medicine, Durham, NC, USA.
Patricia Martinez QuinonesPerelman School of Medicine, Department of Surgery, Division of Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
Kathleen HirschPerelman School of Medicine, Department of Surgery, Division of Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
Kristen DiFiorePerelman School of Medicine, Department of Surgery, Division of Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
Krista HainesDepartment of Surgery, Division of Trauma, Acute and Critical Care Surgery, Duke University School of Medicine, Durham, NC, USA.
Lewis J KaplanPerelman School of Medicine, Department of Surgery, Division of Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
Joseph S Fernandez-MoureDepartment of Surgery, Division of Trauma, Acute and Critical Care Surgery, Duke University School of Medicine, Durham, NC, USA. joseph.fernandezmoure@duke.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe inability to achieve primary fascial closure (PFC) after emergency laparotomy increases the rates of adverse outcomes including fistula formation, incisional hernia, and intraabdominal infection. Hypertonic saline (HTS) infusion improves early PFC rates and decreases time to PFC in patients undergoing damage control laparotomy (DCL) after injury. We hypothesized that in patients undergoing DCL after penetrating abdominal injury, HTS infusion would decrease the time to fascial closure as well as the volume of crystalloid required for resuscitation without inducing clinically relevant acute kidney injury (AKI) or electrolyte derangements.

methodsWe retrospectively analyzed all penetrating abdominal injury patients undergoing DCL within the University of Pennsylvania Health System (January 2015-December 2018). We compared patients who received 3% HTS at 30 mL/h (HTS) to those receiving isotonic fluid (ISO) for resuscitation while the abdominal fascia remained open. Primary outcomes were the rate of early PFC (PFC within 72 h) and time to PFC; secondary outcomes included acute kidney injury, sodium derangement, ventilator-free days, hospital length of stay (LOS), and ICU LOS. Intergroup comparisons occurred by ANOVA and Tukey's comparison, and student's t, and Fischer's exact tests, as appropriate. A Shapiro-Wilk test was performed to determine normality of distribution.

resultsFifty-seven patients underwent DCL after penetrating abdominal injury (ISO n = 41, HTS n = 16). There were no significant intergroup differences in baseline characteristics or injury severity score. Mean time to fascial closure was significantly shorter in HTS (36.37 h ± 14.21 vs 59.05 h ± 50.75, p = 0.02), and the PFC rate was significantly higher in HTS (100% vs 73%, p = 0.01). Mean 24-h fluid and 48-h fluid totals were significantly less in HTS versus ISO (24 h: 5.2L ± 1.7 vs 8.6L ± 2.2, p = 0.01; 48 h: 1.3L ± 1.1 vs 2.6L ± 2.2, p = 0.008). During the first 72 h, peak sodium (Na) concentration (146.2 mEq/L ± 2.94 vs 142.8 mEq/L ± 3.67, p = 0.0017) as well as change in Na from ICU admission (5.1 mEq/L vs 2.3, p = 0.016) were significantly higher in HTS compared to ISO. Patients in the HTS group received significantly more blood in the trauma bay compared to ISO. There were no intergroup differences in intraoperative blood transfusion volume, AKI incidence, change in chloride concentration (△Cl) from ICU admit, Na to Cl gradient (Na:Cl), initial serum creatinine (Cr), peak post-operative Cr, change in creatinine concentration (△Cr) from ICU admission, creatinine clearance (CrCl), initial serum potassium (K), peak ICU K, change in K from ICU admission, initial pH, highest or lowest post-operative pH, mean hospital LOS, ICU LOS, and ventilator-free days.

conclusionsHTS infusion in patients undergoing DCL after penetrating abdominal injury decreases the time to fascial closure and led to 100% early PFC. HTS infusion also decreased resuscitative fluid volume without causing significant AKI or electrolyte derangement. HTS appears to offer a safe and effective fluid management approach in patients who sustain penetrating abdominal injury and DCL to support early PFC without inducing measurable harm. LEVEL OF EVIDENCE: Level III.

Indexed as

Abdominal InjuriesLaparotomyWounds, PenetratingAcute Kidney InjuryAdultFasciotomyFemaleFluid TherapyHumansInjury Severity ScoreLength of StayMaleMiddle AgedRetrospective StudiesSaline Solution, HypertonicSaline Solution, HypertonicDamage control laparotomyHyperchloremic metabolic acidosisHypertonic salinePrimary fascial closureSurgical outcomes

Identifiers

PMID37773464

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