Effectiveness and safety of continuous neuromuscular blockade in trauma patients with an open abdomen: A follow-up study

• Published in: The American journal of surgery 2018-09, Vol.216 (3), p.414-419
• Main Authors: Smith, Susan E., Hamblin, Susan E., Guillamondegui, Oscar D., Gunter, Oliver L., Dennis, Bradley M.
• Format: Article
• Language: English
• Subjects: Abdomen; Adults; Age; Anesthesia; Blood products; Complications; Computational fluid dynamics; Damage control laparotomy; Demographics; Demography; Fistula; Fluids; Gender; Mortality; Neuromuscular blockade; Nutrition; Open abdomen; Patients; Pneumonia; Regression models; Resuscitation; Surgeons; Trauma
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.04.003

Neuromuscular blocking agents (NMBA) have been associated with decreased time to fascial closure following damage control laparotomy (DCL). Changes in resuscitation over the last decade bring this practice into question. A retrospective cohort study of adults who underwent DCL between 2009 and 2015 was conducted at an ACS-verified level 1 trauma center. The study group (NMBA+) received continuous NMBA within 24 h of DCL. Data collected included demographics, resuscitative fluids, mortality, and complications. The primary outcome was time to fascial closure. Factors associated with abdominal closure were determined by ordinal logistic regression. There were 222 patients included (NMBA+ 125; NMBA– 97). Demographics were similar, including median age (NMBA+ 36; NMBA– 39 years) and ISS (NMBA+ 29; NMBA– 34). There was no difference in median time to closure (NMBA+ 2; NMBA– 2 days) or the incidence of complications (NMBA+ 64%; NMBA– 59%). In a regression model, NMBA exposure was not associated with time to abdominal closure. In adult trauma patients requiring DCL, continuous NMBA did not affect the time to abdominal closure. •Early abdominal closure following DCL has been associated with fewer complications.•Adjunctive strategies have been used to facilitate early abdominal closure.•NMBA did not affect the time to abdominal closure following DCL in trauma.•With current resuscitation practices, nearly all patients achieved early closure.•Routine use of NMBA may not be necessary with current management strategies. Neuromuscular blocking agents (NMBA) have previously been associated with decreased time to fascial closure following damage control laparotomy (DCL). Changes in resuscitation over the last decade bring this practice into question. A retrospective cohort study of adult patients who underwent DCL between 2009 and 2015 was conducted at an ACS-verified level 1 trauma center. No association between NMBA exposure and time to abdominal closure was found.