A 48-year-old man is on postoperative day 10 after an emergent laparotomy for severe abdominal trauma. He remains intubated on assist-control ventilation and requires a continuous norepinephrine infusion. His abdomen was left open and is managed with a temporary closure system using negative pressure wound therapy. Over the past 24 hours, nursing staff have noted increasing bilious output from the abdominal wound, consistent with an enteroatmospheric fistula (EAF). Which of the following factors is MOST strongly associated with the development of an EAF in critically ill patients?

A 45-year-old man in the ICU underwent damage-control laparotomy and open abdomen management with continuous negative-pressure wound therapy (–125 mmHg) for severe abdominal sepsis. Over the past 3 weeks, he has had four re-explorations for source control. He remains on assist-control ventilation with a norepinephrine infusion at 0.08 mcg/kg/min, is receiving full enteral nutrition (100% of goal), and has maintained a neutral 24-hour fluid balance. During a dressing change, a new high-output enteroatmospheric fistula is noted draining from the exposed bowel. Which factor most directly led to the development of this fistula?

A 62-year-old man with long-standing, poorly controlled Crohn’s disease complicated by recent unintentional weight loss underwent an emergent laparotomy for perforated diverticulitis 10 days ago. His postoperative course was complicated by severe abdominal sepsis managed with an open abdomen technique. Nursing staff now note increasing bilious output from his abdominal wound, and CT imaging confirms an enteroatmospheric fistula. Which pre-existing chronic condition most significantly contributed to his risk of developing this fistula?

A 62-year-old man was admitted two weeks ago for severe abdominal sepsis requiring damage control surgery and open abdomen management with a temporary closure device. Over this period, he has undergone three additional abdominal re-explorations and received an average of 6 L of fluids per day. His albumin remains low at 2.1 g/dL despite nutritional support. During a dressing change today, an enteroatmospheric fistula is identified. Which of the following risk factors most significantly contributed to the development of his enteroatmospheric fistula?

A 45-year-old man is on hospital day 14 after an emergency laparotomy with open abdomen management for severe abdominal sepsis. His abdomen is managed with negative pressure wound therapy. Nursing staff note approximately 700 mL of enteric output from the wound over 24 hours. Laboratory studies reveal a transferrin level of 180 mg/dL (normal 200–360 mg/dL). Which of the following statements about the classification and likelihood of spontaneous closure of his fistula is most accurate?

A 45-year-old man is in the ICU 10 days after damage-control surgery for severe abdominal sepsis. His open abdomen is managed with a temporary closure system. Over the past 24 hours, nursing staff report high-volume bilious drainage (~600 mL/day) from the abdominal wound. He is tachycardic (125 bpm), hypotensive (85/50 mmHg) despite a norepinephrine infusion, and febrile (38.9 °C). What is the most critical initial management priority?

A 62-year-old man is in the surgical ICU 10 days after a damage-control laparotomy for severe abdominal sepsis. He has developed an enteroatmospheric fistula from the proximal ileum with an output of 850 mL/day. He remains hemodynamically stable but has ongoing systemic inflammation and a prealbumin level of 10 mg/dL despite broad-spectrum antibiotics. Which of the following factors is most critical for determining his immediate prognosis and guiding the timing of definitive surgical repair?

A 45-year-old man is in the surgical intensive care unit 10 days after an exploratory laparotomy for severe abdominal trauma. He is maintained on assist-control ventilation, receiving a continuous norepinephrine infusion at 0.1 mcg/kg/min via a central line, and has an open abdomen managed with negative pressure wound therapy. Over the past 24 hours, the NPWT canister has collected approximately 1200 mL of bilious fluid. His vital signs are: heart rate 110 beats/min, blood pressure 90/55 mmHg, respiratory rate 22 breaths/min, and temperature 38.5°C (101.3°F). Laboratory results include: sodium 130 mEq/L, potassium 3.0 mEq/L, chloride 90 mEq/L, BUN 35 mg/dL, and serum creatinine 1.5 mg/dL. Which of the following interventions is the highest priority for this patient?

A 45-year-old man with severe abdominal sepsis underwent damage-control laparotomy 10 days ago. He now has an open abdomen managed with negative pressure wound therapy. Over the past 24 hours, he has received 7 L of intravenous crystalloid. His vital signs are: HR 100 bpm, BP 110/70 mm Hg on no vasopressors. Laboratory studies show serum albumin 2.1 g/dL. He has had two re-explorations for source control. Which modifiable factor should be optimized first to reduce his risk of developing an enteroatmospheric fistula?

A 62-year-old man is in the ICU 10 days after damage-control laparotomy with an open abdomen for severe abdominal trauma. He is on pressure support ventilation and requires norepinephrine at 0.1 mcg/kg/min via a central line. Over the past 12 hours, he has developed a fever of 39.2 °C, a WBC count of 22,000/mm³ (88% neutrophils), and a lactate of 4.1 mmol/L. Nursing notes new copious purulent drainage from the open abdomen, consistent with an enteroatmospheric fistula. Nasal swab screening on ICU admission was positive for MRSA colonization. Blood cultures are pending. Given this presentation of septic shock secondary to a suspected enteroatmospheric fistula, which of the following is the most appropriate initial empiric antibiotic regimen?