Chasing 100%: the use of hypertonic saline to improve early, primary fascial closure after damage control laparotomy

• Published in: The journal of trauma and acute care surgery Vol. 74; no. 2; p. 426
• Main Authors: Harvin, John A, Mims, Mark M, Duchesne, Juan C, Cox, Jr, Charles S, Wade, Charles E, Holcomb, John B, Cotton, Bryan A
• Format: Journal Article
• Language: English
• Published: United States 01.02.2013
• Subjects: Abdominal Injuries - surgery; Adult; Fasciotomy; Female; Humans; Isotonic Solutions - therapeutic use; Laparotomy - methods; Male; Middle Aged; Resuscitation - methods; Retrospective Studies; Saline Solution, Hypertonic - therapeutic use; Treatment Outcome; Young Adult
• ISSN: 2163-0763
• DOI: 10.1097/TA.0b013e31827e2a96

Failure to achieve fascial closure after damage control laparotomy (DCL) is associated with increased morbidity and long-term disability. In addition, early closure is associated with reduces infectious, wound, and pulmonary complications. We hypothesized that hypertonic saline (HTS), which attenuates resuscitation-induced intestinal edema in animals, would improve early primary fascial closure (EPFC) rates. This is a retrospective study of trauma patients undergoing DCL, from January 2010 to July 2011. Patients in the HTS group had 30 mL/h of 3% sodium chloride as maintenance fluids while the fascia was open. Patients in the cohort group had isotonic fluids (125 mL/h). The primary outcome, EPFC, was defined as primary fascial closure by postinjury day 7. Seventy-seven patients underwent DCL (23 received HTS and 54 received isotonic fluids). There were no differences in demographics, injury severity, or pre-intensive care unit vitals, laboratories, fluids, or transfusions. Median fluids in the first 24 hours were lower in the HTS group (3.9 vs. 7.8 L, p < 0.001). Times to fascial closure were shorter in those receiving HTS (34 vs. 49 hours, p < 0.001), as were the rates of closure at first take back (78% vs. 53%, p = 0.036). The primary outcome of EPFC was higher in the HTS group compared with standard fluids (100% vs. 76%, p = 0.010). At discharge, the HTS group had a 96% primary fascial closure rate compared with 80% with standard fluids. The use of 3% HTS as maintenance fluids after DCL was associated with 100% EPFC. HTS may be used as an adjunct to facilitate fascial closure in patients undergoing DCL. Diagnostic study, level III.