Intraabdominal Lavage of Hypochlorous Acid

A New Paradigm for the Septic and Open Abdomen

Luis G Fernández, MD, KHS, KCOEG, FACS, FASAS, FCCP, FCCM, FICS; Marc R. Matthews, MD, FACS; Lawton Seal, MS, PhD

Disclosures

Wounds. 2020;32(4):107-114. 

In This Article

Abstract and Introduction

Abstract

Introduction: Management of the open abdomen (OA) has rapidly evolved over the last several decades due to the improved understanding of the underlying pathophysiology of patients with an OA, adoption of damage control surgery, and the use of temporary abdominal closure (TAC) techniques for this patient population. The TAC utilizing negative pressure has been successful for managing patients with an OA with improved time to closure. Recent studies have started to examine the use of TAC in conjunction with negative pressure wound therapy with instillation and dwell time (NPWTi-d) for the management of the OA.

Objective: This case series illustrates the capability, safety, and clinical effectiveness of TAC/NPWTi-d with hypochlorous acid (HOCl) solution.

Materials and Methods: Three successfully treated cases describe the use of NPWTi-d using HOCl solution for the management of patients with a septic OA.

Results: This initial experience suggests instillation of HOCl through the tubing set, in conjunction with the TAC device, is safe and easy to use. This technique decreased the need for more frequent OA lavages in the operating room (OR) after the index procedure, as well as the associated concomitant risks of transporting patients who are critically ill between the SICU and OR. No acute complications related to the TAC device with HOCl were noted.

Conclusions: Based on the results of this study, the authors believe instillation through the TAC device may be the next evolution in the use of abdominal NPWT and programmed intermittent lavage of the peritoneal cavity represents an effective method in the care of patients with a septic OA.

Introduction

Direct fluid irrigation of fluid into the peritoneal cavity (abdominal washout) has been an integral part of the management of the septic open abdomen (OA). This approach has been shown to assist in the removal of bacteria, some inflammatory mediators, and other contaminants commonly found in this setting.[1] Abdominal washout is best performed in the operating room (OR). In some patients who are critically ill with a septic OA, this may not be feasible. The authors present 3 cases that describe the use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) using hypochlorous acid (HOCl) solution combined with temporary abdominal closure (TAC) for managing patients with a septic OA.

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