Prediction of postoperative complications after urgent laparotomy by intraperitoneal microdialysis : A pilot study

Prediction of postoperative complications after urgent laparotomy by intraperitoneal microdialysis : A pilot study

The aim of the present study was to investigate the role of intraperitoneal microdialysis (IPM) techniques in monitoring the evolution of postoperative critically ill patients requiring urgent laparotomy. Postoperative intraabdominal sepsis is associated with an important degree of morbidity and mor...

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Bibliographic Details
Published in:Annals of surgery Vol. 244; no. 6; pp. 994 - 1002
Main Authors: VERDANT, Colin L, CHIEREGO, Marialuisa, DE BACKER, Daniel, DE MOOR, Véronique, CHAMLOU, Reza, CRETEUR, Jacques, DE DIEU MUTIJIMA, Jean, LOI, Patricia, GELIN, Michel, GULLO, Antonino, VINCENT, Jean-Louis
Format: Journal Article
Language:English
Published: Hagerstown, MD Lippincott 01-12-2006
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Critical Illness
Female
General aspects
Humans
Lactic Acid - blood
Laparotomy - adverse effects
Male
Medical sciences
Microdialysis
Middle Aged
Original
Peritoneal Dialysis
Pilot Projects
Predictive Value of Tests
Pyruvic Acid - blood
Intraperitoneal
Medicine
Postoperative
Microdialysis
Treatment
Surgery
Prediction
Complication
Predictive factor
Laparotomy
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Summary:The aim of the present study was to investigate the role of intraperitoneal microdialysis (IPM) techniques in monitoring the evolution of postoperative critically ill patients requiring urgent laparotomy. Postoperative intraabdominal sepsis is associated with an important degree of morbidity and mortality in acutely ill patients. Early diagnosis is critical to improve outcomes. : The study included 25 consecutive patients admitted to the intensive care unit (ICU) after urgent laparotomy. Measurements of microdialysate fluid were performed through a microdialysis catheter, positioned intraperitoneally, during the first 5 postoperative days and lactate/pyruvate (L/P) ratios calculated. Patients were followed until hospital discharge. Ten patients had a complicated postoperative course, including 4 deaths (3 refractory shock, 1 mesenteric ischemia), 3 reinterventions (1 necrotic collection, 1 mesenteric ischemia, 1 biliary leak), 2 secondary peritonitis, and 1 intraabdominal collection. The IPM L/P ratio in these patients was already significantly higher during the first 24 postoperative hours compared with patients who had no complications (35 +/- 21 vs. 18 +/- 6, P < 0.01). An IPM L/P ratio above 22 on postoperative day 1 had a sensitivity of 0.64 and a specificity of 0.79 for complications. There were no significant differences between the two groups in pH, lactate, white blood cell count, or subcutaneous L/P ratio. No complication was associated with the technique. IPM is safe and reliable and provides valuable information after urgent laparotomy. Persistently high L/P values should raise the possibility of serious postoperative complications.
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ISSN:0003-4932
1528-1140
DOI:10.1097/01.sla.0000225092.45734.e6