AIM

Open abdomen management (OAM) is now used for non-traumatic conditions like gastrointestinal ischemia. The optimal sedation strategy for patients undergoing OAM is unclear, especially for light sedation. We evaluate the feasibility of targeted lighter sedation in patients undergoing OAM.

METHODS

We retrospectively studied non-trauma patients undergoing OAM in the ICU. A lighter sedation was implemented for a cohort of patients than the conventional sedation target in an earlier cohort. In our strategy, we set a goal of sedation depth of 0 to -2 on the Richmond Agitation and Sedation Scale (RASS) for patients without abdominal compartment syndrome, active bleeding, or requiring continuous muscle relaxants. Primary outcomes were whether or not each patient experienced light sedation (RASS -2 to 0) at least once during OAM and propofol dosage during OAM, calculated as milligrams per kilogram of body weight per hour (mg/kg/h).

RESULTS

Thirty-two patients were included in each cohort. The primary indications for OAM were gastrointestinal ischemia and gastrointestinal perforation. Before implementation of the strategy, 13 patients (41%) had lighter sedation at least once during OAM, compared with 27 (84%) after implementation. The mean propofol dosage during OAM was 1.30 ± 0.94 before and 1.07 ± 0.68 after (adjusted mean difference -0.27 mg/kg/h; 95% confidence interval (CI) -0.71 to 0.17). After abdominal closure, patients with lighter sedation could be weaned from ventilation faster than those with deeper sedation (P=0.015) and were also discharged from the ICU earlier (P=0.013). There were no adverse events requiring emergent abdominal exploration during OAM.

CONCLUSIONS

A targeted light sedation strategy for non-trauma patients undergoing OAM was suggested to be feasible, safe, and associated with earlier liberation from mechanical ventilation and ICU, suggesting potential clinical benefits. These findings should be confirmed in future prospective, multicenter studies.