Highlights from AAST - Use of hypertonic saline to help abdominal closure

CHASING 100%: THE USE OF HYPERTONIC SALINE TO IMPROVE EARLY FASCIAL CLOSURE RATES FOLLOWING DAMAGE CONTROL LAPAROTOMY John Harvin, Mark Mims, Juan Duchesne, MD, Charles E. Wade*, Ph.D., John B. Holcomb*, M.D., Charles Cox, Jr.*, MD, Bryan A. Cotton*, M.D., University of Texas Health Science Center-Houston Invited Discussant: Eileen M. Bulger Introduction: Failure to achieve fascial closure after damage control laparotomy (DCL) is associated with increased morbidity and long-term disability. We hypothesized that hypertonic saline (HTS), which reverses resuscitation-induced intestinal edema in animals, would improve early primary fascial closure (EPFC) rates. Methods: Prospective study of trauma patients undergoing DCL, 01/10-07/11. HTS group: 30 mL/hr of 3% NaCl as maintenance fluids while fascia was open. Cohort group: isotonic fluids (at 125 mL/hr). Primary outcome: EPFC, defined as primary fascial closure by post-injury day 7. Secondary outcomes: time to closure, closure at first take-back. Results: Seventy-seven patients underwent DCL (23 received HTS, 54 received isotonic fluids). There were no differences in demographics, injury severity, and pre-ICU vitals, labs, fluids or transfusions. Rates of closure at first take-back and EPFC were higher in the HTS group (TABLE). At discharge, HTS patients had a 96% primary fascial closure rate compared to 80% with standard fluids. Isotonic (n=54) Median 24-hour fluids, L (IQR) Median time to closure, hr (IQR) Closure at first take-back, % Fascial closure by day 7, % 7.8 (5.7, 10.2) 49 (36, 126) 53% 76% HTS (n=23) 3.9 (2.9, 6.4) 34 (22, 45) 78% 100% p-value <0.001 <0.001 0.036 0.010 Conclusion: The use of 3% HTS as maintenance fluids following DCL was associated with 100% EPFC. Previous data has shown that earlier closure reduces infectious, wound and pulmonary complications. HTS may be used an adjunct to facilitate fascial closure in patients undergoing DCL.