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Active Negative Pressure Peritoneal Therapy After Abbreviated Laparotomy: The Intraperitoneal Vacuum Randomized
Andrew W Kirkpatrick1, Derek J Roberts, Peter D Faris
1*Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada †Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada ‡Department of Community Health Sciences, University of Calgary, TRW (Teaching, Research, and Wellness), Calgary, Alberta, Canada §Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada ¶Alberta Health Services-Research Excellence Support Team, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada ‖Department of Oncology, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada **Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada ††Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary, Health Research Innovation Centre, Calgary, Alberta, Canada; and ‡‡Hotchkiss Brain Institute, University of Calgary and the Foothills Medical Centre, Health Research Innovation Centre, Calgary, Alberta, Canada.
Objective:
To determine whether active negative pressure peritoneal therapy with the ABThera temporary abdominal closure device reduces systemic inflammation after abbreviated laparotomy.
Background:
Excessive systemic inflammation after abdominal injury or intra-abdominal sepsis is associated with poor outcomes.
Methods:
We conducted a single-center, randomized controlled trial. Forty-five adults with abdominal injury (46.7%) or intra-abdominal sepsis (52.3%) were randomly allocated to the ABThera (n = 23) or Barker's vacuum pack (n = 22). On study days 1, 2, 3, 7, and 28, blood and peritoneal fluid were collected. The primary endpoint was the difference in the plasma concentration of interleukin-6 (IL-6) 24 and 48 hours after temporary abdominal closure application.
Results:
There was a significantly lower peritoneal fluid drainage from the ABThera at 48 hours after randomization. Despite this, there was no difference in plasma concentration of IL-6 at baseline versus 24 (P = 0.52) or 48 hours (P = 0.82) between the groups. There was also no significant intergroup difference in the plasma concentrations of IL-1β, -8, -10, or -12 p70 or tumor necrosis factor α between these time points. The cumulative incidence of primary fascial closure at 90 days was similar between groups (hazard ratio, 1.6; 95% confidence interval, 0.82-3.0; P = 0.17). However, 90-day mortality was improved in the ABThera group (hazard ratio, 0.32; 95% confidence interval, 0.11-0.93; P = 0.04).
Conclusions:
This trial observed a survival difference between patients randomized to the ABThera versus Barker's vacuum pack that did not seem to be mediated by an improvement in peritoneal fluid drainage, fascial closure rates, or markers of systemic inflammation.
Trial Registration:
ClinicalTrials.gov identifier NCT01355094.
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