Intentional open abdominal management of severe trauma and other visceral catastrophic illness is becoming increasingly common in the ICU. Benefits to selected critically ill patients include prevention and treatment of intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS), the facilitation of serial operations where damage control tactics have been employed, the stabilization of traumatic abdominal wall defects, the prevention and treatment of necrotizing fasciitis and necrotizing pancreatitis, and lavage therapy for peritonitis. Physicians caring for the critically ill need to be familiar with the concepts and practice of temporary abdominal coverage (TAC) and staged abdominal procedures.