Differentiated Approach to Antihypoxic, Endoportal and Phage Therapy for Advanced Purulent Peritonitis

Abstract

The purpose of this study was to evaluate the results of differentiated use of enteral antihypoxic therapy (EAT), endoportal therapy (EPT), as well as phage therapy (PT) in patients with diffuse purulent peritonitis complicated by acute intestinal failure (AIF). Materials and Methods: 144 patients with diffuse peritonitis and AIF were treated. The patients were divided into two equal comparable groups: main (n=72) and comparison (n=72). In addition, each group was divided into three subgroups (24 patients each) depending on the degree of AIF. The groups were distributed using adaptive randomization. EAT was carried out by introducing oxygenated water through a nasogastrointestinal (NGI) tube. EPT was carried out by introducing an antibiotic, a hepatoprotector and an antihypoxant through a catheter into the portal system. PT was carried out by introducing a polyvalent bacteriophage through a NGI tube. The following were dynamically studied: EMFC, APACHE II, abdominal cavity index (ACI), acid-base status and blood gas composition, integral intestinal pressure (IIP), intra-abdominal pressure (IAP). Comparison of quantitative indicators in the study groups was carried out using the Wilcoxon-Mann-Whitney U test, as well as its multivariate generalization - the Kruskal-Wallis test, for checking the equality of medians of several samples. Results: The dynamic study of IIP and IAP in the study groups on the day 3 of treatment, showed significantly lower values in the main group (p≤0.05). There was a more rapid decrease in the manifestations of hypoxia in the main group, which was confirmed by an increase in the oxygen partial pressure in the blood. The average number of bed days in the intensive care unit was 4.2±0.3 days in the comparison group, and 3.3±0.2 days in the study group. The overall average number of bed-days was 15.8 in the study group, and 18.5 in the comparison group. Mortality was 16.3% in the comparison group, and 11.3% in the study group (a decrease of 30.7%). Thus, when prescribing NGI, EAT, EPT and PT, one should be guided by the severity of organ dysfunction and the AIF stage. With values of ACI <13, APACHE II <10 and EMFC <5, NGI and EAT are indicated. With ACI 14-22, APACHE II 10-15, EMFC 5-25 - NGI and EAT are supplemented with PT. In the most severe cases, with ACI ≥23, APACHE II >16 and EMFC >25 points, EPT must be added to the above treatment methods. Conclusion: The proposed scheme for the differentiated use of EPT, EAT and PT in patients with diffuse peritonitis complicated by AIF allows to relatively quickly stop inflammation and prevent the development of multiple organ failure and sepsis.