Trauma and Acute Care Sanford Medical Center Fargo, United States
Introduction: In patients requiring abbreviated exploratory laparotomies, mortality remains high. These patients constitute a critical care population with limited physiological reserves and an urgent need for improved studies within this subgroup. These patients frequently present in septic shock, making fluid resuscitation a critical cornerstone of their management. The literature shows a correlation between fluid overload and negative patient outcomes. However, critical care literature remains mixed on the best methods to determine a patient's fluid overload status. Commonly, a patient's weight gain is used, but this presents issues in the emergent surgical population, as a patient's baseline fluid weight is often unknown. This study examines the impact of the peak fluid index (the highest amount of fluid gained, starting from 0L at presentation) on mortality.
Methods: A retrospective chart review was conducted from 2013-2023 for all patients who underwent abbreviated exploratory laparotomy with the placement of negative pressure wound therapy (ABThera) instead of initial fascial closure. 540 patients met the inclusion criteria. Peak fluid index was determined as the highest net fluid gain during a patient's admission. Variables assessed included mortality, time to abdominal closure, ICU length of stay, hospital length of stay, ventilation days, and number of days on pressors.
Results: Logistic regression revealed that peak fluid index significantly increased a patient’s mortality by 3% for every additional liter of fluid. Additionally, for every liter of fluid, there was an increase in time until fascial closure by 1.51 hours.
Conclusions: This study contributes to the critical care literature by demonstrating a direct correlation between the amount of fluid gained and mortality in critically ill surgical patients with an open abdomen. The significant increase in mortality (3% for every additional liter of net fluid gain) highlights an area for individualized care improvement in this population. This data also helps define a universally assessable variable, the peak fluid index. Further analysis is being conducted to determine if there is a specific rate of fluid gain associated with increased mortality.
