Impacto del manejo respiratorio en el abdomen abierto en los pacientes críticos: revisión de alcance

Abstract

Background

The open abdomen (OA) technique is frequently used in trauma, sepsis, and abdominal compartment syndrome (ACS). However, the respiratory impact of OA —particularly its relationship with intra-abdominal pressure (IAP), mechanical ventilation strategies, and pulmonary complications— remains insufficiently defined. This scoping review aimed to summarize current evidence on respiratory complications and ventilatory management in critically ill patients with OA.

Methods

A scoping review following PRISMA-ScR guidelines was conducted using PubMed, Web of Science, and Scopus (2010–2024). Studies involving adult ICU patients with OA and reporting respiratory outcomes or ventilatory strategies were included. Data were synthesized narratively, tabulated, and complemented with bibliometric mapping.

Results

Of 479 studies identified, 5 met inclusion criteria. The most frequent respiratory complications were acute respiratory distress syndrome (ARDS), ventilator-associated pneumonia (VAP), and reduced pulmonary compliance in the context of elevated IAP. Ventilatory strategies varied, but lung-protective ventilation and individualized PEEP titration based on IAP were consistently recommended. Evidence suggests that selected OA patients may be extubated prior to fascial closure.

Conclusions

This scoping review identified limited evidence suggest that OA affects respiratory mechanics, particularly pulmonary compliance and airway pressures in the context of elevated IAP. The scarcity of available evidence prevents the establishment of formal ventilatory recommendations. Important knowledge gaps are identified in: standardized ventilation targets, criteria for early extubation, and respiratory considerations in the timing of abdominal closure.