Anatolii I Sukhodolia and Kostiantyn Yu Krenov*

National Pirogov Memorial Medical University, Bogomoletz Institute of Physiology of the National Academy of Medical Sciences of Ukraine, Khmelnytskyi Regional Hospital Municipal Non-Profit Enterprise of Khmelnytskyi Regional Council, Ukraine

*Corresponding Author: Kostiantyn Yu Krenov, National Pirogov Memorial Medical University, Bogomoletz Institute of Physiology of the National Academy of Medical Sciences of Ukraine, Khmelnytskyi Regional Hospital Municipal Non-Profit Enterprise of Khmelnytskyi Regional Council, Ukraine.

Received: May 15, 2023; Published: May 14, 2023

Abstract

Introduction: Peritonitis is the most frequent complication of surgical emergencies of the abdominal organs and their injuries. This pathology is the cause of death in about 60% of cases of surgical emergencies. The course of this pathology depends on the nature and duration of the disease, the responsiveness of the macroorganism, and methods of treatment. Usually, several microorganisms act as an etiological factor. Urgent surgical treatment in order to eliminate the source of infection using the concept of damage control surgery, early adequate antibiotic therapy, the use of fluid resuscitation, inotropic and vasopressor support, efferent methods of therapy can minimize the development of complications and further progression of the disease with the implementation of the pattern of sepsis and septic shock, and save the lives of patients [32,33].

Materials and Methods: Literature sources of the PubMed database under the tags of ‘peritonitis’, ‘sepsis’, ‘destructive pancreatitis’ over the past 10 years were analysed.

Conclusion: Peritonitis and abdominal sepsis associated with its progression, despite the pluricausal structure of the pathology, require unified treatment approaches. Early sanitation of the pocket of infection, maintaining microcirculation at the proper level, the use of the principles of damage control surgery, and the early adequate prescription of antibiotic therapy with the creation of an appropriate concentration of drugs in the pocket is the key to success in the treatment of this category of patients.

 Keywords: Peritonitis; Abdominal Sepsis; Septic Shock; Resuscitation

References

1. Abdul-Aziz MH., et al. “Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort”. Journal of Antimicrobial Chemotherapy1 (2015): 196-207.
2. Atema JJ., et al. “External Validation of a Decision Tool to Guide Post-Operative Management of Patients with Secondary Peritonitis”. Surgical Infections (Larchmt)18 (207): 189-195.
3. Bala M., et al. “Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery”. World Journal of Emergency Surgery1 (2022).
4. Boele van Hensbroek P., et al. “Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen”. World Journal of Surgery2 (2008): 199-207.
5. Brink A., et al. “Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score. Lopez-Delgado JC, editor”. PLOS ONE1 (2019): e0211133.
6. Brown RM., et al. “Balanced Crystalloids versus Saline in Sepsis. A Secondary Analysis of the SMART Clinical Trial”. American Journal of Respiratory and Critical Care Medicine12 (2019): 1487-1495.
7. Budkule D., et al. “An outcome analysis of videoscopic assisted retroperitoneal debridement in infected pancreatic necrosis: a single centre experience. Turkish Journal of Surgery3 (2019): 214-222.
8. Capobianco A., et al. “The peritoneum: healing, immunity, and diseases. The Journal of Pathology2 (2017): 137-147.
9. Chen S-H., et al. “Effects of endotoxin adsorber hemoperfusion on sublingual microcirculation in patients with septic shock: a randomized controlled trial. Annals of Intensive Care1 (2020): 80.
10. Clements TW., et al. “Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scandinavian Journal of Surgery (2021): 145749692098407.
11. De Waele JJ., et al. “Risk factors for target non-attainment during empirical treatment with β-lactam antibiotics in critically ill patients. Intensive Care Medicine9 (2014): 1340-1351.
12. Douglas IS., et al. “Fluid Response Evaluation in Sepsis Hypotension and Shock. Chest4 (2020): 1431-1445.
13. Fujii T., et al. “Polymyxin B-immobilised haemoperfusion and mortality in critically ill patients with sepsis/septic shock: a protocol for a systematic review and meta-analysis. BMJ Open11 (2016): e012908.
14. Gavelli F., et al. “Management of sepsis and septic shock in the emergency department. Internal and Emergency Medicine6 (2021): 1649-61.
15. Global Alliance for Infections in Surgery Working Group. “A global declaration on appropriate use of antimicrobial agents across the surgical pathway”. Surgical Infection (Larchmt) 18.8 (2017): 846-853.
16. Grosomanidis V., et al. “Cardiovascular effects of increased intra-abdominal pressure in pigs with or without coexistent sepsis”. The Greek E-Journal of Perioperative Medicine 17 (2018): 37-60.
17. Hernández G., et al. “Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock”. JAMA7 (2019): 654-664.
18. Honore PM., et al. “Cytokine removal in human septic shock: Where are we and where are we going?” Annals of Intensive Care1 (2019): 56.
19. Honore PM., et al. “Cytokine removal in human septic shock: Where are we and where are we going?” Annals of Intensive Care1 (2019): 56.
20. Kanoore Edul VS., et al. “What is microcirculatory shock?” Current Opinion in Critical Care3 (2015): 245-252.
21. Kara A., et al. “Monitoring microcirculation in critical illness”. Current Opinion in Critical Care5 (2016): 444-452.
22. Kastelein AW., et al. “Embryology, anatomy, physiology and pathophysiology of the peritoneum and the peritoneal vasculature”. Seminars in Cell & Developmental Biology 92 (2019): 27-36.
23. Kirkpatrick AW., et al. “Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial”. World Journal of Emergency Surgery1 (2018): 26.
24. Lankisch PG., et al. “Acute pancreatitis”. The Lancet9988 (2015): 85-96.
25. Mahmoud S and Shen C. “Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing”. Pharmaceutics4 (2017): 36.
26. Montero A., et al. “Antimicrobial management in nosocomial peritonitis: microbiota, drug and time”. Revista Espanola De Quimioterapia : Publicacion Oficial de la Sociedad Espanola de Quimioterapia 30 (2017): 34-38
27. Montravers P., et al. “Priorities in peritonitis”. Current Opinion in Critical Care2 (2020): 201-207.
28. Montravers P., et al. “Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial”. Intensive Care Medicine3 (2018): 300-310.
29. Nishibori M., et al. “Specific removal of monocytes from peripheral blood of septic patients by Polymyxin В-immobilized filter column”. Acta Med Okayama1 (2009): 65-69.
30. Packialakshmi B., et al. “Large animal models for translational research in acute kidney injury”. Renal Failure1 (2020): 1042-1058.
31. Pandompatam G., et al. “The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock”. Revista Brasileira de Terapia Intensiva3 (2019).
32. Perathoner A., et al. “Damage control with abdominal vacuum therapy (VAC) to manage perforated diverticulitis with advanced generalized peritonitis—a proof of concept”. International Journal of Colorectal Disease 6 (2010): 767-774.
33. Perdue PW., et al. “The Use of Local and Systemic Antibiotics in Rat Fecal Peritonitis”. Journal of Surgical Research 3 (1994): 360-365.
34. Perego AF., et al. “Polymyxin-B direct hemoperfusion (PMX-DHP) ingram negative sepsis”. Giornale Italiano di Nefrologia 6 (2007): 628-629.
35. Perez F and Bonomo RA. “Can we really use beta-lactam/beta-lactam inhibitor combinations for the treatment of infections caused by extended-spectrum beta-lactamase-producing bacteria?” Clinical Infectious Diseases 2 (2012): 175-177.
36. Pezzilli R., et al. “Consensus guidelines on severe acute pancreatitis. Digestive and Liver Disease 7 (2015): 532-543.
37. Piccioni A., et al. “Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department”. Medicina 9 (2021): 920.
38. Roberts JA., et al. “DALI: Defining Antibiotic Levels in Intensive Care Unit Patients: Are Current -Lactam Antibiotic Doses Sufficient for Critically Ill Patients?” Clinical Infectious Diseases 8 (2014): 1072-1083.
39. Sartelli M., et al. “Duration of antimicrobial therapy in treating complicated intra-abdominal infections: a comprehensive review”. Surgical Infections (Larchmt)1 (2016): 9-12.
40. Sartelli M., et al. “Antimicrobials: a global alliance for optimizing their rational use in intraabdominal infections (AGORA)”. World Journal of Emergency Surgery1 (2016): 33.
41. Sartelli M., et al. “WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections”. World Journal of Emergency Surgery 16 (2021): 49.
42. Sawyer RG., et al. “Trial of short-course antimicrobial therapy for intraabdominal infection”. The New England Journal of Medicine 21 (2015): 1996-2005.
43. Shoji H and Opal SM. “Therapeutic Rationale for Endotoxin Removal with Polymyxin B Immobilized Fiber Column (PMX) for Septic Shock”. International Journal of Molecular Sciences4 (2021): 2228.
44. Singer M., et al. “The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)”. JAMA 8 (2016): 801-810.
45. Singer M. “The role of mitochondrial dysfunction in sepsis-induced multi-organ failure”. Virulence 1 (2013): 66-72.
46. Tucker RV., et al. “Sepsis-Induced Cardiomyopathy Detected With Focused Cardiac Ultrasound in the Emergency Department”. The Journal of Emergency Medicine 4 (2022): e91-99.
47. Udy AA., et al. “Augmented Renal Clearance in the ICU”. Critical Care Medicine 3 (2014): 520-527.
48. Van Baal JO., et al. “The histophysiology and pathophysiology of the peritoneum”. Tissue and Cell 1 (2017): 95-105.
49. van Regenmortel N., et al. “Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers”. British Journal of Anaesthesia 6 (2017): 892-900.
50. Yajnik V and Maarouf R. “Sepsis and the microcirculation: the impact on outcomes”. Current Opinion in Anaesthesiology2 (2022): 230-235.

Citation

Citation: Anatolii I Sukhodolia and Kostiantyn Yu Krenov. “Current Trends in Intensive Therapy of Peritonitis and Abdominal Sepsis". Acta Scientific Gastrointestinal Disorders 6.7 (2023): 10-17.

Copyright

Copyright: © 2023 Anatolii I Sukhodolia and Kostiantyn Yu Krenov. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.