Tertiary peritonitis: considerations for complex team-based care

Abstract

Peritonitis, as a major consequence of hollow visceral perforation, anastomotic disruption, ischemic necrosis, or other injuries of the gastrointestinal tract, often drives acute care in the emergency department, operating room, and the ICU. Chronic critical illness (CCI) represents a devastating challenge in modern surgical critical care where successful interventions have fostered a growing cohort of patients with prolonged dependence on mechanical ventilation and other organ supportive therapies who would previously have succumbed much earlier in the acute phase of critical illness. An important subset of CCI patients are those who have survived an emergency abdominal operation, but who subsequently require prolonged open abdomen management complicated by persistent peritoneal space infection or colonization, fistula formation, and gastrointestinal (GI) tract dysfunction; these patients are described as having tertiary peritonitis (TP).The organ dysfunction cascade in TP terminates in death in between 30 and 64% of patients. This narrative review describes key—but not all—elements in a framework for the coordinate multiprofessional team-based management of a patient with tertiary peritonitis to mitigate this risk of death and promote recovery. Given the prolonged critical illness course of this unique patient population, early and recurrent Palliative Care Medicine consultation helps establish goals of care, support adjustment to changes in life circumstance, and enable patient and family centered care.

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

“…Recent advances in intensive care have led to improved outcomes in the treatment of secondary peritonitis. It should be noted that understanding changes in the human microbiome in secondary peritonitis is an emerging field and may lead to new potential therapeutic targets [9][10][11][12][13].…”

Chronic Critical Illness-Induced Muscle Atrophy: Insights From a Trauma Mouse Model and Potential Mechanism Mediated via Serum Amyloid A

“…Chronic critical illness (CCI) refers to a condition where patients who have survived the initial critical illness in the intensive care unit (ICU) continue to experience ongoing complications, leading to a secondary peak of “late deaths” (1–3). Chronic critical illness was featured by ongoing catabolism syndrome as evidenced by significant weight loss (4), endocrine dysfunction (5), elevation of proinflammation (4), and suppression of adaptive immunity (2), and this status was increasingly evident because of significant improvements in the support of life (1,6).…”

Endovascular therapy in the combination treatment of widespread purulent peritonitis

“…Перитонит остается одним из самых тяжелых и значимых в клинической практике осложнений заболеваний и травм органов брюшной полости и смежных областей [1,2]. Лечение распространенных форм гнойного перитонита (РГП) остается актуальной проблемой в связи с сохраняющимися неудовлетворительными результатами лечения [3][4][5]. Методы программируемой санационной релапаротомии (ПСРЛ), управляемой лапаростомии, перитонеального лаважа не привели к значимому улучшению результатов лечения РГП.…”

“…Методы программируемой санационной релапаротомии (ПСРЛ), управляемой лапаростомии, перитонеального лаважа не привели к значимому улучшению результатов лечения РГП. Летальность при РГП достигает 32,38-70,00 % [2,6,7], и обусловлена прогрессированием воспалительного процесса в брюшной полости [7,8], возникновением несформированных кишечных свищей (НКС) [9] и полиорганной недостаточностью на фоне инфекционно-токсического шока [4,7]. Их возникновение, по мнению ряда авторов, связано в значительной степени с развитием ишемии и гипоксии воспаленных стенок кишечника и брюшины [6,9,10].…”