Staged Abdominal Repair in Critical Illness

Anaesth Intens Care 1996; 24: 368-374

Staged Abdominal Repair in Critical Illness J. TORRIE*, A. A. HILL†, S. STREAT‡ Departments of Anaesthesia and Critical Care Medicine and the University Department of Surgery, Auckland Hospital, Auckland, New Zealand

SUMMARY Marlex mesh interposition as part of staged abdominal repair (M-STAR) was used on 68 occasions to reduce pressure during abdominal closure (46), facilitate multiple laparotomies (15), both indications (4) or defect repair (3), in 66 critical care admissions (median APACHE-II=21). Physiological data before and after M-STAR performed for intra-abdominal pressure were retrospectively available on 33/36 ventilated occasions. Compliance improved (median Vt/[Paw-PEEP] 22.6 vs 30.3 ml/cm H2O, P60 ml/h (66-350, median 101 pre-M-STAR to 30-375, median 142 post-M-STAR). Table 3 Values (median, range) of various parameters immediately before and after 33 instances of M-STAR performed for elevated intraabdominal pressure Parameter (units)

Before

After

PaO2 91 (53-187) 98 (64-465) (mmHg) 0.6 (0.3-1.0) 0.6 (0.4-1.0) FiO2 PaO2/FiO2 (mmHg) 136 (68-468) 175 (74-465) PaCO2 (mmHg) 39 (27-53) 38 (26-57) VE (l/m) 10 (5.5-18.0) 11 (5.5-17.5) VE/PaCO2 (ml/min/mmHg) 244 (143-516) 289 (96-500) 6.0 (0-15) 10 (0-18) PEEP (cm H2O) 40 (28-55) 39 (20-52) Paw (cm H2O) Vt (ml) 750 (450-1450) 850 (500-1250) Vt/[paw-PEEP] 23 (11-45) 30 (18-59) (ml/cm H2O) pHa 7.30 (7.17-7.5) 7.33 (7.09-7.48) BE (mmol/l) –6 (–15-+1) –5 (–13-+2) HR (beats/min) 130 (75-180) 110 (70-170) MAP (mmHg) 100 (70-110) 95 (65-120) Dopamine (mg/hr) 36 (0-60) 30 (0-78) Noradrenaline (mg/hr) 0.5 (0-3.8) 0.3 (0-8.8) Hrly urine flow (ml) 60 (9-350) 110 (5-780) (mean of 2 hours)

Difference

Wilcoxon P-value

7 (–105-278)

NS

0 (–0.1-0.6)

0.016

–3 (–263-180)

NS

–1 (–19-19) 0 (–2.5-5)

NS NS

12 (–121-211) 0 (–5-9) –3 (–33-7) 0 (–200-600)

NS NS 0.0018 0.014

5 (–8-29) 0.23 (–0.3-.03) 1 (–11-10) –5 (–40-25) 0 (–30-25)