Interventional management of abdominal sepsis: when and how

Goor, van Harry

doi:10.1007/s00423-002-0309-7

Cited by 35 publications

(18 citation statements)

References 54 publications

(60 reference statements)

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“…In 20–40% of patients with severe infection, re-exploration is required. Re-exploration performed when there are signs of persistent infection or when findings of organ failure emerge generally causes a delay in the diagnosis and treatment of intra-abdominal complications or collections [5]. However, with appropriate patient monitoring (e.g., sufficient monitorization, use of abdominal CT), the damage from potential delays can be prevented [6].…”

Section: Discussionmentioning

confidence: 99%

Bogota Bag Use in Planned Re-Laparotomies

et al. 2016

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BackgroundPlanned re-laparotomies are a series of surgical interventions that are rarely used and have a high mortality rate. The aim of this study was to investigate the factors affecting mortality and the effectiveness of the use of the Bogota bag for temporary closure of the abdomen in patients for whom re-laparotomy was planned.Material/MethodsA retrospective examination was made of data of patients in whom a Bogota bag was used in planned re-laparotomies for various reasons in the General Surgery Department of Suleyman Demirel University Medical Faculty between June 2008 and April 2014.ResultsBogota bags were used in a total of 38 patients, comprising 23 (60.5%) males and 15 (39.5%) females, with a mean age of 58.94±17.89 years. The mean period of hospitalization was 14.5 days (range, 1–143 days) and the mean number of operations during that time was 3 (range, 1–11). The mean duration of intensive care unit stay was 6 days (range, 1–143 days). Malignancy was determined in 8 patients (21.1%). Indications were intra-abdominal sepsis in 23 patients (60.5%), mesenteric vascular disease in 10 patients (26.3%), and packing was required in 5 patients (13.2%). Mortality developed in 25 patients (65.8%). A significant relationship was determined between mortality and a diagnosis of mesenteric artery ischemia (p: 0.035). The mortality rate was 56% (n: 13) in patients diagnosed with intra-abdominal sepsis. A relationship was determined between mortality and age (p: 0.015), duration of hospital stay (p: 0.007), need for cardiac inotrope (p: 0.01), and need for mechanical ventilation (p: 0.01). The mean Apache II score was 26.4±5 for patients who died and 15.8±5.2 for surviving patients (p<0.001). In 5 (38.4%) of the 13 surviving patients, primary repair was applied to the abdomen, and in the remaining 8 patients abdominal wall repair was performed using dual mesh.ConclusionsIn patients in whom a Bogota bag was used, which is a cheap and easy method for temporary closure of the abdomen, the high mortality rates seen are related to diagnosis, Apache II score, age, and organ failure.

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Section: Discussionmentioning

confidence: 99%

Bogota Bag Use in Planned Re-Laparotomies

et al. 2016

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“…It has long been known that patients in intensive care suffering from shock, infection, or trauma react inadequately to a renewed challenge like surgery. This has also been called the phenomenon of the second hit . Despite not always appreciating the precise cause of the connection with inflammation, many surgeons know that a low serum albumin level is a bad omen for outcome after surgery .…”

Section: Hypoalbuminemia and Outcomementioning

confidence: 99%

Hypoalbuminemia: Pathogenesis and Clinical Significance

Soeters

Wolfe

Shenkin

2018

J Parenter Enteral Nutr

713

554

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Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half‐life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin “from the shelf” is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.

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“…Accurate and timely selection of patients for relaparotomy is a prerequisite for improvement of the treatment of secondary peritonitis, especially regarding the growing popularity of the on-demand relaparotomy strategy compared to other relaparotomy strategies [3, 4, 19,27,28,29,30]. Particularly the on-demand strategy encompasses extensive monitoring and multidisciplinary care with frequent radiological imaging and adjustments of treatment policy at every stage of the acute disease, as this strategy harbors the risk of a potentially harmful delay.…”

Section: Discussionmentioning

confidence: 99%

Decision Making for Relaparotomy in Secondary Peritonitis

Ruler¹,

Lamme²,

Vos³

et al. 2008

Dig Surg

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Background/Aims: To provide a qualitative ranking of clinical variables by surgeons that influence their decision for reoperation and to evaluate whether these variables are related to positive findings at relaparotomy. Methods: Importance in decision making for relaparotomy was evaluated for 21 factors using a 10-point visual analogue scale (VAS). Variables with median VAS scores >5.0 were labeled ‘important’. Predictive value for positive findings was evaluated by multivariate analysis. Results: The response rate was 64%. For each variable, a wide range of VAS scores was given. Of variables labeled ‘important’, a diffuse extent of abdominal contamination (odds ratio, OR 1.9; 95% CI 0.99–3.8; p = 0.052), localization of the infectious focus (upper gastrointestinal tract including small bowel: OR 2.6, 95% CI 0.98–7.0, p = 0.055; colon: OR 2.4, 95% CI 0.93–6.0, p = 0.071), and both low (<3 × 10⁹/l: OR 4.6, 95% CI 1.3–17, p = 0.021) and high (>20 × 10⁹/l: OR 2.2, 95% CI 1.0–4.9, p = 0.042) leukocyte counts independently predicted positive relaparotomy. As a set, these variables had only moderate predictive accuracy (c-statistic 0.69). Conclusions: There was no consensus among surgeons which variables were important in decision making for relaparotomy. Only three out of ten variables labeled as ‘important’ were indeed independently predictive, but even as a set had only moderate predictive accuracy.

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Interventional management of abdominal sepsis: when and how

Cited by 35 publications

References 54 publications

Bogota Bag Use in Planned Re-Laparotomies

Bogota Bag Use in Planned Re-Laparotomies

Hypoalbuminemia: Pathogenesis and Clinical Significance

Decision Making for Relaparotomy in Secondary Peritonitis

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