Peritoneal resuscitation improves outcomes in trauma patients

Last Updated: 2017-02-23

By Will Boggs MD

NEW YORK (Reuters Health) - Peritoneal resuscitation improves outcomes of trauma patients undergoing damage-control surgery (DCS), according to results from a randomized controlled trial.

Dr. Jason W. Smith and colleagues from Louisville Veterans Affairs Medical Center and the University of Louisville, Kentucky, previously showed the protective effects produced by application of a hypertonic glucose-based peritoneal dialysis fluid to the peritoneal cavity (peritoneal resuscitation, PR) in a rodent model of hemorrhagic shock; in a retrospective study, they showed that PR was tied to improved surgical outcomes following DCS in trauma patients.

For the new study, they tested whether PR could reduce systemic inflammation, improve abdominal closure rates, and reduce morbidity in a randomized trial of 110 patients treated with DCS following severe injury.

The PR group had consistently reduced multi-organ dysfunction score (MODS) from 24 hours onward, compared with the control group, although the rate of increase and reduction over time did not differ between the groups.

There was no discernible pattern in 14 of 16 cytokines measured, but IL-6 and TNF-alpha concentrations were significantly lower in the PR group by 24 and 12 hours, respectively, the researchers report in the Journal of the American College of Surgeons, online January 27.

The PR group had a reduced time to abdominal closure, higher primary fascial closure rate, and required a reduced number of operations to achieve these goals, compared with the control group.

The number of ICU days and overall 30-day mortality were significantly lower in the PR group than in the control group.

In multivariable analysis, there was a trend towards greater survival in the PR group than in the control group (odds ratio, 2.4; p=0.06), but the study was underpowered to demonstrate a significant difference.

“Peritoneal resuscitation should be considered in all trauma patients requiring damage control surgery to treat their injuries, and further multicenter trials may be worthwhile to evaluate several findings that were reduced but not to clinically significant levels,” the researchers conclude.

Dr. Marcelo A. F. Ribeiro Jr. from Santo Amaro University in Sao Paulo, Brazil, who was not involved in the study, has researched various aspects of DCS. He told Reuters Health by email, “The current role for PR so far is in trauma patients after damage-control laparotomy. Another potential benefit may be in patients that present other critical abdominal conditions like peritoneal sepsis and even to increase the number of organs procured per donor after acute brain death.”

“There is a tremendous potential benefit for trauma patients to increase overall survival, decrease complication rates, and increase primary fascial closure,” he said.

Dr. Ribeiro added, “Future larger multicenter trials must be done in order to elucidate the real benefit of this technique. There is also a need for a trial in abdominal sepsis to try to reproduce the same level of success as presented for trauma patients.”

Dr. Smith did not respond to a request for comments.

SOURCE: http://bit.ly/2ltpLe3

J Am Coll Surg 2017.