Direct Peritoneal Resuscitation (DPR) Improves Acute Physiology and Chronic Health Evaluation (APACHE) IV and Acute Physiology Score When Used in Damage Control Laparotomies: Prospective Cohort Study on 37 Patients
Authors:   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Okumura Kenji , Latifi Rifat ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Smiley Abbas ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Lee Joon Sub ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Shnaydman Ilya ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Zangbar Bardiya ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Bronstein Matthew ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Con Jorge ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Prabhakaran Kartik ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Rhee Peter ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Klein Joshua ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Shivaraj Kiran ,   Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, Klein Michael D. ,   Division of Nephrology, Westchester Medical Center, Valhalla, New York, Miller Daniel M. ,   Critical Care Medicine, Department of Medicine, Westchester Medical Center, New York,  Medical College, Valhalla, New York
Published: October 2022

Introduction: Using direct peritoneal resuscitation (DPR) as an adjunct when managing patients undergoing damage control laparotomy (DCL) shows promising results. We report our initial experience in utilizing DPR when managing patients who underwent DCL for emergent surgery at the index operation. Materials and Methods: We prospectively collected data on 37 patients between August 2020 to October 2021 who underwent DCL with open abdomens after the index operation and utilized DPR. DPR was performed using peritoneal lavage with DIANEAL PD-2-D 2.5% Ca 3.5 mEq/L at a rate of 400ml/hour. Patients’ physiological scores and clinical outcomes were evaluated. Results: 86% required DCL and DPR due to septic abdomen/bowel ischemia. The median (interquartile range [IQR]) age was 62 years (53–70); 62% were male, and median (IQR) body mass index was 30.0kg/m2 (25.5–38.4). On DPR initiation, median (IQR) APACHE-IV score was 48 (33–64) and median (IQR) Acute Physiology Score (APS) was 31 (18–54). After initiation, median (IQR) APACHE-IV score and median (IQR) APS were 39 (21–62) and 19 (11–56), respectively, and both showed significant improvement in survivors (p<0.05). Median (IQR) DPR duration was four days (2–8) and primary abdominal closure was achieved in 30 patients (81%). There were eight mortalities (21.6%) within 30 days postoperatively, of which seven were within 3–24 days due to uncontrolled sepsis/multiple organ failure. The most frequent complication was surgical-site infection recorded in 12 patients (32%). Twenty-four patients (67%) were discharged home/transferred to a rehab center/nursing home. Conclusion: DPR application showed significant improvement of APACHE-IV score and APS in patients with peritonitis/septic abdomen.