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Fri Apr 23 14:12:35 BST 2004

I have had good success weaning and extubating patients with open
abdomens if they are ready from a pulmonary standpoint.  If  the abdomen
is frozen, then you are already committed to a major reconstruction down
the road.  If not, things may depend on how you are managing the
abdomen.  I have been able to continue to work toward closure using a
Whitman patch.  The patient may require some analgesia and sedation when
it is tightened, but this can be done in the ICU.  I have also had good
luck using the wound vac on extubated patients.
Good luck.
Alison Wilson

>>> karim at trauma.org 4/23/04 2:20:35 AM >>>

We currently have 3 open abdomens on our ICU - one GSW to the
IVC/renal
vein, one acute pancreatitis & necrotising enterocolitis & one ischemic
gut.
2 of these patients would meet criteria for extubation were it not for
their
similarity to the teletubbies - ie they manage good tidal volumes and
have
low work of breathing requirements on minimal support.

The standard feeling here though is that attempts to wean and
spontaneous
breathing cause further retraction of the abdominal wall and will make
later
closure impossible or at least more challenging.

Is there any evidence to support this?  General impressions - do you
wait
for closure before weaning?

Karim

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Ventilating open abdomens