The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review

Ribeiro-Júnior, Marcelo Augusto Fontenelle; Costa, Cássia Tiemi Kawase; Augusto, Samara de Souza; Néder, Paola Rezende; Elia, Yasmin Garcia Batista; Rattan, Rishi; Saverio, Salomone Di

doi:10.1007/s00068-021-01821-x

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…More broadly, research is also needed to determine the role and effects of direct peritoneal resuscitation on post-DCL outcomes. To date, studies on direct peritoneal resuscitation have been performed primarily on animals [ 30 ], and little is known about its effect on clinically relevant outcomes. One randomized trial [ 31 ], including 52 patients undergoing damage control surgery, found that patients randomized to peritoneal resuscitation had higher rates of abdominal wall closure with reduced times to it, and lower rates of intra-abdominal infections.…”

Section: Discussionmentioning

confidence: 99%

Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial

et al. 2023

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Background Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control. Methods Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL. Results The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001). Conclusion This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).

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Section: Discussionmentioning

confidence: 99%

Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial

et al. 2023

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“…DPR consists of the intraabdominal instillation of the hypertonic solution to facilitate abdominal closure following damage control laparotomy. The technique has been extensively studied for patients in hemorrhagic shock without contamination; however, no literature could be identified that discusses the use of DPR in an uncontrolled and contaminated field [3]. We believe this to be the first case report of the novel use of DPR in an acute abdomen.…”

Section: Introductionmentioning

confidence: 93%

“…Direct peritoneal resuscitation (DPR) has been introduced within the past decade as a viable solution to improve visceral blood flow, reduce bowel edema to allow earlier abdominal closure, and lessen serum levels of inflammatory cytokines, in addition to other mediators [3]. DPR consists of the intraabdominal instillation of the hypertonic solution to facilitate abdominal closure following damage control laparotomy.…”

Section: Introductionmentioning

confidence: 99%

An Unusual Presentation of Crohn’s Disease and Novel Use of Direct Peritoneal Resuscitation

Juhng¹,

Samad²,

Shelton³

et al. 2022

IJSCR

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Crohn’s disease is an inflammatory bowel disease characterized by transmural inflammation, with the majority of patients having small bowel involvement, usually the distal ileum. Typical manifestations include a prolonged course of abdominal pain, diarrhea, fatigue, and weight loss. We report a case of a 21-year-old male who presented with an acute abdomen and was in profound shock resulting in cardiac arrest. The patient underwent damage control, exploratory laparotomy complicated by acute hypoxic respiratory failure requiring veno-venous extracorporeal membrane oxygenation and the novel use of direct peritoneal resuscitation in the setting of an acute abdomen with an uncontrolled enterotomy and bowel spillage. Our case report illustrates the importance of prompt surgical intervention and critical care with the application of novel surgical techniques to minimize mortality in an unusual presentation of Chron’s disease.

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“…A new advance in experimental shock resuscitation is that adjunct/direct peritoneal resuscitation (DPR) with clinical commercial 2.5% (glucose) lactate-based peritoneal dialysis solution (L-PDS, Dianeal PD 2, 396 mOsm/L) in resuscitation from hemorrhagic shock in 2003 (Zakaria et al, 2003a;Zakaria et al, 2003b). The peritoneal resuscitation was intensively investigated by adjuvant to regular IV resuscitation or alone in animal models, and its clinical case reports also received attention recently (Smith et al, 2014;McKenzie et al, 2017;Ribeiro-Junior et al, 2022). The favorable features of DPR are mainly due to prompt and persistent visceral vasodilation via the improvement of endothelial function and NO generation to dilate visceral microcirculation induced by the hyperosmolarity of PDS in the abdominal cavity, appreciably reversing visceral hypoperfusion.…”

Section: Pyruvate-peritoneal Dialysis Solution In Adjunct Peritoneal ...mentioning

confidence: 99%

Advantages of pyruvate-based fluids in preclinical shock resuscitation-A narrative review

Zhou

2022

Front. Physiol.

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This review focuses on the innate beneficial effects of sodium pyruvate-based fluids, including pyruvate in intravenous solutions, oral rehydration solutions, and peritoneal dialysis solutions, on shock resuscitation with various animal models relative to current commercial fluids over the last two decades. Due to its superior pharmacological properties, pyruvate effectively sustains cytosolic glycolytic pathways and mitochondrial oxidative phosphorylation by restoration of redox potentials and reactivation of pyruvate dehydrogenase in hypoxia, even anoxia, and diabetes, reversing the Warburg effect and diabetic glucometabolic aberration. Pyruvate has been demonstrated to protect against multiorgan dysfunction and metabolic disturbance in numerous preclinical studies with various pathogenic injuries. The unique features of pyruvate potential clinical benefits encompass to efficiently correct lethal lactic acidosis via metabolically rapid consumption of intracellular [H+] and robustly protect multiorgan metabolism and function, particularly visceral organs in addition to the heart and brain, significantly prolonging survival in various animal models. Pyruvate protection of red blood cell function and preservation of the partial pressure of arterial oxygen should be highly concerned in further studies. Pyruvate is much advantageous over existing anions such as acetate, bicarbonate, chloride, and lactate in commercial fluids. Pyruvate-based fluids act as a therapeutic agent without causing iatrogenic resuscitation injury in addition to being a volume expander, indicating a potential novel generation of resuscitation fluids, including crystalloids and colloids. Pyruvate-based fluids have an enormous potential appeal for clinicians who face the ongoing fluid debate to readily select as the first resuscitation fluid. Clinical trials with pyruvate-based fluids in shock resuscitation are urgently warranted.

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The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review

Cited by 8 publications

References 24 publications

Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial

Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial

An Unusual Presentation of Crohn’s Disease and Novel Use of Direct Peritoneal Resuscitation

Advantages of pyruvate-based fluids in preclinical shock resuscitation-A narrative review

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