Open Abdomen as an Effective Therapy for Abdominal Sepsis, Bedside Assistance for the Surgeon

Abdominal sepsis is the second most common cause of sepsis that needs intensive care (IC) management and is associated with high morbidity and mortality rates. Abdominal infections can present themselves as collections (abscesses) or can be diffuse (peritonitis), triggering an immune response. Assessing patients with sepsis or septic shock should be performed by the systemic inflammatory response syndrome/SIRS criteria. The sequential organ failure assessment/SOFA score can be used to evaluate the involved organ systems. Surgery or minimal access procedure is almost always needed, often as part of damage control surgery, and consists of identification of the source, debridement of necrotic or infected tissues, abscess and fluid drainage and irrigation. Multiple reinterventions are not uncommon to get adequate level of source control. To accommodate quick and easy reinterventions in selected exceptional risk circumstances, temporary abdominal closure (TAC) devices can be used to bridge in-between operations until primary closure can be obtained. This should avoid fascial lateralization. Mesh-mediated fascial tractions (MMFT) combined with negative pressure technique (NPT) is currently the golden standard as TAC.