Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy

Purpose To estimate the change in intra-abdominal pressure (IAP) among critically ill patient who were left with open abdomen and temporary abdominal closure after laparotomy, during the first 48 h after admission. Methods A cohort study in a single ICU in a tertiary care hospital. All adult patients admitted to the ICU after emergent laparotomy for acute abdomen or trauma, who were left with temporary abdominal closure (TAC), were included. Patients were followed up to 48 h. IAP was routinely measured at 0, 6, 12, 24, and 48 h after admission to ICU. Results Thirty-nine patients were included, 34 were operated due to acute abdomen and 5 due to abdominal trauma. Seventeen patients were treated with skin closure, 13 with Bogota bag, and 9 with negative pressure wound therapy (NPWT). Eleven patients (28.2%) had IAP of 15 mmHg or above at time 0, (mean pressure 19.0 +/- 3.0 mmHg), and it dropped to 12 +/- 4 mmHg within 48 h (p < 0.01). Reduction in lactate level (2.4 +/- 1.0 to 1.2 +/- 0.2 mmol/L, p < 0.01) and increase in PaO2/FiO(2) ratio (163 +/- 34 to 231 +/- 83, p = 0.03) were observed as well after 48 h. Conclusions This is the first large report of IAP in open abdomen. Elevated IAP may be measured in open abdomen and may subsequently relieve after 48 h.