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So my hospital's surg/trauma icu is a closed unit. (i.e. - the primary team has input and makes the decisions concerning such things as their surgical plan. However, the ICU residents and staff handle all of the rest)
So, many pt's with open abdomens make it to the ICU intubated. I like to extubate these folks immediately if they're otherwise candidates rather than leave them on a vent for two days while they await a washout.
Many of our surgeons however, request the anesthesiologist doing the case to leave them intubated and bring them to us and have informed the family that the patient will be on a vent for awhile. (and occasionally get upset when they find them not smoking the plastic cigar later that evening)
In the patient who comes to day surgery, otherwise healthy, and has something like an abscess that necessitates leaving the belly open with a wound vac, I don't feel this is in the patients best interest and generally extubate these folks. If they wake up, they're less likely to get PNA, DVT, and they can sometimes eat, visit with their families, etc.
And actually, they could (and I often do) be sent to the floor that day, or even avoid the ICU completely, saving a lot of $$$, lab tests, sleepless nights, etc.
From a technical standpoint, the old "wound retraction" argument doesn't seem to have much in the way of support from the literature, and besides, with a wound vac, these abdomens are essentially closed and don't suffer this headache as they did with abdomens left open (which I agree should probably be left tubed, since there is no abdominal wall support for breathing/coughing.
So what's the beef?
I'm interested to hear different sides, whether or not you extubate these healthy folks (obviously not sick, septic patients on pressors, etc) or whether you prefer to leave somebody on a vent, in my opinion, essentially exposing them to all the hazards that entails even for only a couple days, for what I see as essentially lacking any reason, other than antiquated surgeon preference.
So, many pt's with open abdomens make it to the ICU intubated. I like to extubate these folks immediately if they're otherwise candidates rather than leave them on a vent for two days while they await a washout.
Many of our surgeons however, request the anesthesiologist doing the case to leave them intubated and bring them to us and have informed the family that the patient will be on a vent for awhile. (and occasionally get upset when they find them not smoking the plastic cigar later that evening)
In the patient who comes to day surgery, otherwise healthy, and has something like an abscess that necessitates leaving the belly open with a wound vac, I don't feel this is in the patients best interest and generally extubate these folks. If they wake up, they're less likely to get PNA, DVT, and they can sometimes eat, visit with their families, etc.
And actually, they could (and I often do) be sent to the floor that day, or even avoid the ICU completely, saving a lot of $$$, lab tests, sleepless nights, etc.
From a technical standpoint, the old "wound retraction" argument doesn't seem to have much in the way of support from the literature, and besides, with a wound vac, these abdomens are essentially closed and don't suffer this headache as they did with abdomens left open (which I agree should probably be left tubed, since there is no abdominal wall support for breathing/coughing.
So what's the beef?
I'm interested to hear different sides, whether or not you extubate these healthy folks (obviously not sick, septic patients on pressors, etc) or whether you prefer to leave somebody on a vent, in my opinion, essentially exposing them to all the hazards that entails even for only a couple days, for what I see as essentially lacking any reason, other than antiquated surgeon preference.
