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Open abdominal management for perforative peritonitis with septic shock: a retrospective analysis on usefulness of a standardized treatment protocol

  • Koichi InukaiEmail author
  • Akihiro Usui
  • Motohiko Yamada
  • Koji Amano
  • Nobutaka Mukai
  • Yusuke Tsunetoshi
  • Yasuki Nakata
  • Junichiro Yokota
Original Article
  • 80 Downloads

Abstract

Background

Damage control surgery (DCS) with open abdominal management (OAM) has been increasingly expanded to include critically ill non-trauma patients. However, there is limited data regarding the usefulness of this protocol for the treatment of severe perforative peritonitis (PP), especially with septic shock (SS). Here, we retrospectively evaluated the usefulness of our OAM protocol for PP with SS.

Methods

We retrospectively reviewed patients with from June 2015 to September 2018. The proposed protocol was composed of the following steps: (1) rapid control of contamination; (2) temporary abdominal closure; (3) repeated washout of the abdominal cavity; and (4) delayed definitive surgery. For temporary abdominal closure, a negative pressure wound therapy device was used. The end points were the morbidity and 30-day mortality rates. Logistic backward regression was performed to identify factors associated with complications.

Results

The mortality rate was 4% (1/25) and the overall morbidity rate of surviving patients was 58.3% (14/24). The mean duration of the first DCS was 67.36 ± 22.83 min. The median durations of ventilation and intensive care unit stay were 5 and 7 days, respectively. Although not significant, morbidity might be associated with age, diabetes mellitus, initial operative time, and OAM duration.

Conclusions

A standardized protocol for OAM may improve the outcomes of patients with SS due to PP. This damage control approach can be applied for the treatment of severe abdominal sepsis.

Keywords

Damage control surgery Open abdominal management Perforative peritonitis Secondary peritonitis Septic shock 

Abbreviations

DCS

Damage control surgery

NPWT

Negative pressure wound therapy

OAM

Open abdominal management

PP

Perforative peritonitis

SS

Septic shock

WBC

White blood cell

BMI

Body mass index

COPD

Chronic obstructive pulmonary disease

ICU

Intensive care unit

Notes

Author contributions

KI drafted the manuscript. AU, MY, KA, NM, YT, and YN critically revised the article for important intellectual content. JY is the Department Chairperson and supervised the writing of the manuscript. All of the authors approved the final version of the manuscript.

Funding

Not applicable.

Compliance with ethical standards

Conflict of interest

The authors have no competing interests to declare.

Ethics approval and consent to participate

Ethical approval was obtained from Institutional Review Board of Sakai City Medical Hospital. Consent to participate was not applicable owing to the retrospective nature of the study.

Consent for publication

Not applicable.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Acute Care SurgerySakai City Medical CenterSakaiJapan

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