1788: SHORTER SEDATION TIME INCREASES PROPORTION OF COMA-/DELIRIUM-FREE DAYS AFTER OPEN ABDOMEN FOR TRAUMA

Learning Objectives: Damage control with temporary abdominal closure is the standard of care for critically injured patients requiring laparotomy. These patients are often kept sedated pending primary fascial closure of the abdomen. However, best sedation practices for these patients, particularly with multiple risk factors for delirium, have not been well established. We hypothesized that a shorter duration of exposure to sedative infusions would be associated with an increased proportion of coma-free delirium-free ICU days in patients with an open abdomen after trauma. Methods: We queried the trauma registry at a single ACS-verified level I adult trauma center over a 5 year period for patients who underwent damage control with temporary abdominal closure after trauma. We then obtained clinical and demographic data, including injury severity score (ISS), presence of small bowel, colon, and abdominal vascular injuries, type of temporary abdominal closure, length of time until primary fascial closure, and the du- ration of sedative infusion exposure (propofol, dexmetetomidine, and benzodiazepines). Patients were classified based on shorter than median or longer than median sedation exposure. Children, prisoners, and pregnant women were excluded. Standard parametric methods were used for basic statistics. We performed linear regression analysis to determine the effect of age, ISS, bowel discontinuity, abdominal vascular injury, and short or long sedation exposure on the proportion of coma-free delirium-free ICU days. Results: We obtained data on 66 patients. Mean age was 41.5 ± 16.0 years. Mean ISS was 27.0 ± 14.1. Mean ICU stay was 13.3 ± 13.0 days; mean ventilator dependence was 9.0 ± 9.9 days; mean hospital stay was 20.9 ± 16.9 days. Mean proportion of coma-free delirium-free ICU days was 26.5%±26.8%. Primary fascial closure was achieved in 69.8 ± 68.3 hours in 59/66 patients. Median length of sedation exposure was 2.1 days [interquartile range 6.2 days]. After adjusting for age, ISS, bowel discontinuity, and abdominal vascu- lar injury, longer than median sedation exposure was associated with a 12.7% decrease in the proportion of coma-free delirium- free ICU days [95%CI 0.8%, 24.6%, p = 0.037]. Conclusions: In a multivariate analysis of a retrospective single- center population, we demonstrate for the first time that patients with shorter length of sedation have increased proportion of coma-free delirium-free ICU days after damage control with open abdomen for trauma.