gms | German Medical Science

Objectives: Open abdomen (OA) has become a standard care in abdominal emergencies. However, high volume fluid therapy in this setting contributes to excessive visceral edema, delayed fascial closure and prolonged parenteral nutrition. The aim of this study was to determine whether bioelectrical impedance analysis (BIA)-directed fluid resuscitation, compared with traditional resuscitation, resulted in lower postoperative fluid overload, earlier fascial closure and initiation of enteral nutrition (EN), higher fascial closure rates, and overall improved outcomes in OA trauma patients.

Methods: A prospective study was performed in a national gastrointestinal referral center. Patients were randomly sub grouped into two groups: BIA-directed resuscitation (BIA) and traditional resuscitation (TRD). Study end point were rate of 30-day primary fascial closure (PFC), 7-day fluid balance and 30-day mortality.

Results: Forty-eight patients were included, 30 in BIA and 18 in TRD group). The 30-day PFC rate was 70 % for BIA patients and 27.78 % for TRD group (p = 0.005). Fluid resuscitation with the BIA allowed lower fluid input at POD 3, 4, higher fluid output at POD 2, 3, 4, 7, lower fluid balance at POD 2, 3, 4, 5, and lower cumulative fluid balance at POD 3, 4, 5, 6, 7. Compared with TRD group, BIA-directed fluid resuscitation resulted in a lower enterocutaneous fistula (ECF) rate, pneumonia rate, and reduced ventilator days and ICU length of stay. Multivariate Cox regression analysis identified that BIA patients were significantly more likely to achieve PFC than TRD patients[HR 5.90 (95 % confidence interval, 1.54-22.63)]. Multivariate linear regression analysis for time to fascial closure, initiate EN, and cumulative fluid balance were carried out to adjust for confounding factors, which allowed earlier fascial closure (by an average of 4.24 days, p < 0.001), initiation of EN (by an average of 5.9 days, p < 0.001), and lower cumulative fluid balance (by an average of 6777.17 ml, p < 0.001).

Conclusion: Our study demonstrates that BIA-directed fluid resuscitation is associated with lower postoperative fluid overload, higher 30-day PFC rates, earlier fascial closure and initiation of EN among trauma patients who require OA. BIA might be advocated to be monitored routinely in OA trauma patients.