Marcelo Augusto Fontenelle Ribeiro-Junior1, Cássia Tiemi Kawase Costa2, Samara de Souza Augusto2, Paola Rezende Néder2, Yasmin Garcia Batista Elia2, Rishi Rattan3, Salomone Di Saverio4,5,6. 1. Division of Trauma and General Surgery, Hospital Municipal Dr. Jose de Carvalho Florence, Faculdade de Ciências Médicas de São José dos Campos, Humanitas, Catholic University of São Paulo, Rua Joubert Wey, 290, Vila Boa Vista, Sorocaba, SP, Brazil. drmribeiro@gmail.com. 2. Medical School, University of Santo Amaro, Rua Professor Enéas de Siqueira Neto, 340, Jardim das Imbuias, São Paulo, SP, Brazil. 3. Division of Trauma Surgery and Critical Care, Leonard M. Miller School of Medicine, University of Miami, Miami, USA. 4. Cambridge University Hospitals NHS Trust, Cambridge, UK. salomone.disaverio@gmail.com. 5. General Surgery Dept., ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, AP, Italy. salomone.disaverio@gmail.com. 6. Dipartimento di Chirurgia Generale e Specialistica "Paride Stefanini", La Sapienza University of Rome, Rome, Italy. salomone.disaverio@gmail.com.
Abstract
PURPOSE: Direct peritoneal resuscitation (DPR) has been used to help preserve microcirculation by reversing vasoconstriction and hypoperfusion associated with the pathophysiological process of shock, which can occur despite appropriate intravenous resuscitation. This approach depends on infusing a hyperosmolar solution intraperitoneally via a percutaneous catheter with the tip ending near the pelvis or the root of the mesentery. The abdomen is usually left open with a negative pressure abdominal dressing to continuously evacuate the infused dialysate. Hypertonicity of the solution triggers visceral vasodilation to help maintain blood flow, even during shock, and is also associated with reduced local inflammatory cytokines and other mediators, preservation of endothelial cell function, and mitigation of organ edema and necrosis. It also has a direct effect on liver perfusion and edema, more rapidly corrects electrolyte abnormalities compared to intravenous resuscitation alone, and may requireless intravenous fluid to stabilize blood pressure, all of which shortens the time required to close patients' abdomen. METHODS: An online query using the search term "direct peritoneal resuscitation" was carried out in PubMed, MEDLINE and SciELO, limited to publications indexed from January 2014 to June 2020. Of the 20 articles returned, full text was able to be obtained for 19. A manual review of included articles' references was resulted in the addition of 1 article, for a total of 20 included articles. RESULTS: The 20 articles were comprised of 15 animal studies, 4 clinical studies,and 1 expert opinion. The benefits include both local and possibly systemic effects on perfusion, hypoxia, acidosis, and inflammation, and are associated with improved outcomes and reduced complications. CONCLUSION: DPR shows promise in patients with hemorrhagic shock, septic shock, and other conditions resulting in an open abdomen after damage control laparotomy.
PURPOSE: Direct peritoneal resuscitation (DPR) has been used to help preserve microcirculation by reversing vasoconstriction and hypoperfusion associated with the pathophysiological process of shock, which can occur despite appropriate intravenous resuscitation. This approach depends on infusing a hyperosmolar solution intraperitoneally via a percutaneous catheter with the tip ending near the pelvis or the root of the mesentery. The abdomen is usually left open with a negative pressure abdominal dressing to continuously evacuate the infused dialysate. Hypertonicity of the solution triggers visceral vasodilation to help maintain blood flow, even during shock, and is also associated with reduced local inflammatory cytokines and other mediators, preservation of endothelial cell function, and mitigation of organ edema and necrosis. It also has a direct effect on liver perfusion and edema, more rapidly corrects electrolyte abnormalities compared to intravenous resuscitation alone, and may requireless intravenous fluid to stabilize blood pressure, all of which shortens the time required to close patients' abdomen. METHODS: An online query using the search term "direct peritoneal resuscitation" was carried out in PubMed, MEDLINE and SciELO, limited to publications indexed from January 2014 to June 2020. Of the 20 articles returned, full text was able to be obtained for 19. A manual review of included articles' references was resulted in the addition of 1 article, for a total of 20 included articles. RESULTS: The 20 articles were comprised of 15 animal studies, 4 clinical studies,and 1 expert opinion. The benefits include both local and possibly systemic effects on perfusion, hypoxia, acidosis, and inflammation, and are associated with improved outcomes and reduced complications. CONCLUSION: DPR shows promise in patients with hemorrhagic shock, septic shock, and other conditions resulting in an open abdomen after damage control laparotomy.
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