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Klinichna Khirurhiia Sep 2002
Review
Topics: Humans; Laparotomy; Peritoneal Lavage; Peritonitis; Reoperation
PubMed: 12378942
DOI: No ID Found -
The American Journal of Emergency... Nov 2003Diagnostic peritoneal lavage (DPL) is one of the most useful tools in the diagnosis of intraperitoneal injuries secondary to stab wounds. The lavage catheter is inserted...
Diagnostic peritoneal lavage (DPL) is one of the most useful tools in the diagnosis of intraperitoneal injuries secondary to stab wounds. The lavage catheter is inserted into the peritoneal cavity through a surgical incision or a blind puncture. Complications related to the catheter insertion were previously reported in both techniques. We describe 2 cases in which the lavage catheter was inserted through the stab wound itself after local wound exploration clearly demonstrated violation of the peritoneum. We suggest that in anterior abdominal stab wounds, the DPL can be safely and effectively performed through the stab wound if penetration to the peritoneum is diagnosed.
Topics: Abdominal Injuries; Adolescent; Humans; Male; Middle Aged; Peritoneal Lavage; Peritoneum; Wounds, Stab
PubMed: 14655237
DOI: 10.1016/s0735-6757(03)00099-8 -
Journal of the American College of... Apr 2015Brain dead organ donors have altered central hemodynamic performance, impaired hormone physiology, exaggerated systemic inflammatory response, end-organ microcirculatory... (Comparative Study)
Comparative Study
BACKGROUND
Brain dead organ donors have altered central hemodynamic performance, impaired hormone physiology, exaggerated systemic inflammatory response, end-organ microcirculatory dysfunction, and tissue hypoxia. A new treatment, direct peritoneal resuscitation (DPR), stabilizes vital organ blood flow after conventionally resuscitated shock to improve these derangements.
STUDY DESIGN
A prospective case-control study of adjunctive DPR compared 26 experimental patients (brain dead organ donors) to 52 controls (protocolized conventionally resuscitated donors). Actual organ procurement rates were compared with the Scientific Registry of Transplant Recipient predicted organ yield per patient. Achievement of donor management goals and effective hepatic blood flow were recorded.
RESULTS
Fourteen of 26 (53.8%) patients treated with DPR achieved all donor management goals compared with 17 of 52 (32.7%) patients treated with conventionally resuscitated (odds ratio = 2.4; 95% CI, 0.92-6.3; p = 0.06). Patients treated with DPR were more than 2 times as likely to achieve final pO2 >100 on 40% FiO2 compared with controls (odds ratio = 2.8; 95% CI, 1-7.69; p = 0.03). Also, DPR-treated patients required less IV crystalloid during the first 12 hours of management (DPR: 3,167 ± 1,893 mL vs 4,154 ± 2,100 mL; p = 0.046) and required less vasopressor agents at 12 hours post resuscitation (odds ratio = 7.7; 95% CI, 0.82-42; p = 0.02). Direct peritoneal resuscitation patients had enhanced effective hepatic blood flow and significantly higher organs transplanted per donor rates compared with controls (3.7 ± 1.7 vs 3.1 ± 1.3; p = 0.024).
CONCLUSIONS
Direct peritoneal resuscitation reduced IV fluid requirement and IV pressor use as well as increased hepatic blood flow and organs transplanted per donor. Direct peritoneal resuscitation studies show it to be a safe, effective method to augment organ donor resuscitation and additional large-scale trials should be conducted to validate these findings.
Topics: Adolescent; Adult; Aged; Brain Death; Cadaver; Case-Control Studies; Female; Humans; Male; Microcirculation; Middle Aged; Peritoneal Lavage; Prospective Studies; Resuscitation; Tissue Donors; Tissue and Organ Procurement; Young Adult
PubMed: 25797737
DOI: 10.1016/j.jamcollsurg.2014.12.056 -
The American Journal of Emergency... Jan 1993The authors compared the speed of cooling and treatment efficacy for evaporative cooling versus iced peritoneal lavage in a canine heatstroke model. Nine random-source,... (Comparative Study)
Comparative Study
The authors compared the speed of cooling and treatment efficacy for evaporative cooling versus iced peritoneal lavage in a canine heatstroke model. Nine random-source, mongrel dogs were anesthetized, shaved, and internally heated until the core temperature reached 43.0 degrees C. The animals were then randomly assigned to be cooled to 37 degrees C either by sterile normal saline (6 degrees C) continuous peritoneal lavage at 250 mL/min (n = 4), or by spraying with tap water (15 degrees C, 12 L/min) before a large fan blowing room temperature air (23 degrees C) across the dog at 0.5 m/sec from a height of 50 cm (n = 5). Temperatures were monitored by thermocouples in both tympanic membranes. Electrocardiogram, blood pressure, and pulse were continuously monitored. Evaporative cooling was as rapid as iced peritoneal lavage (0.18 +/- .03 versus 0.17 +/- .07 degrees C/min/m2, P = NS). All animals survived, although one animal in each treatment group demonstrated a moderate neurologic deficit when measured 48 hours following resuscitation. A simple noninvasive evaporative cooling technique, readily available in the emergency department, appears to be as rapid readily available in the emergency department, appears to be as rapid and effective as aggressive peritoneal lavage for cooling and treating heatstroke in the dog.
Topics: Animals; Blood Pressure; Body Temperature; Cryotherapy; Dogs; Electrocardiography; Heat Exhaustion; Peritoneal Lavage; Pulse; Time Factors
PubMed: 8447861
DOI: 10.1016/0735-6757(93)90047-f -
The British Journal of Surgery Oct 2021The standard treatment for Hinchey III perforated diverticulitis with peritonitis was resection with or without a stoma, but recent trials have shown that laparoscopic...
BACKGROUND
The standard treatment for Hinchey III perforated diverticulitis with peritonitis was resection with or without a stoma, but recent trials have shown that laparoscopic lavage is a reasonable alternative. This registry-based Swedish study investigated results at a national level to assess safety in real-world scenarios.
METHODS
Patients in Sweden who underwent emergency surgery for perforated diverticulitis between 2016 and 2018 were studied. Inverse probability weighting by propensity score was used to adjust for confounding factors.
RESULTS
A total of 499 patients were included in this study. Laparoscopic lavage was associated with a significantly lower 90-day Comprehensive Complication Index (20.9 versus 32.0; odds ratio 0.77, 95 per cent compatibility interval (c.i.) 0.61 to 0.97) and overall duration of hospital stay (9 versus 15 days; ratio of means 0.84, 95 per cent c.i. 0.74 to 0.96) compared with resection. Patients had 82 (95 per cent c.i. 39 to 140) per cent more readmissions following lavage than resection (27.2 versus 21.0 per cent), but similar reoperation rates. More co-morbidity was noted among patients who underwent resection than those who had laparoscopic lavage.
CONCLUSION
Laparoscopic lavage is safe in routine care beyond trial evaluations.
Topics: Aged; Diverticulitis, Colonic; Female; Humans; Intestinal Perforation; Laparoscopy; Length of Stay; Male; Middle Aged; Patient Readmission; Peritoneal Lavage; Postoperative Complications; Propensity Score; Registries; Reoperation; Retrospective Studies; Sweden; Treatment Outcome
PubMed: 34148084
DOI: 10.1093/bjs/znab211 -
Journal of Surgical Education 2011During the last 2 decades, the advent of new technologies in trauma patient care may have resulted in a decreased number of diagnostic peritoneal lavage (DPL)...
OBJECTIVES
During the last 2 decades, the advent of new technologies in trauma patient care may have resulted in a decreased number of diagnostic peritoneal lavage (DPL) evaluations. In this study, it is hypothesized that fewer DPL are being performed at a midwestern trauma center. Such negative trends may make the inclusion of DPL in current trauma education potentially outdated and no longer universally appropriate in trauma evaluation algorithms.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective observational study of a level I trauma center includes patients from January 1998 through September 2010. The total number of trauma-related DPL procedures performed annually during the study period was determined along with accompanying facility and trauma patient level data.
RESULTS
A total of 24 DPLs were performed at the target trauma center during the study period. There was a significant decrease (p = 0.0018) in the use of DPL despite a significant increase (p < 0.0001) in the proportion of trauma patients with an injury severity score > 15.
CONCLUSIONS
Study data demonstrated a decrease in the use of DPL as a diagnostic modality in the evaluation of blunt abdominal trauma patients at a medium-sized midwestern center. These data provide historic facility-level evidence of a practice change. Such information may support a recommendation that the American College of Surgeons revisit its current curriculum for Advanced Trauma Life Support (ATLS). Specifically, we propose the American College of Surgeons consider changing DPL instruction to an optional component of ATLS. COMPETENCIES: Patient Care, Medical Knowledge, Practice Based Learning and Improvement.
Topics: Abdominal Injuries; Adult; Aged; Aged, 80 and over; Clinical Competence; Cohort Studies; Education, Medical, Graduate; Female; Humans; Male; Middle Aged; Peritoneal Lavage; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Trauma Centers; Traumatology; Treatment Outcome; Wounds, Nonpenetrating; Young Adult
PubMed: 21708370
DOI: 10.1016/j.jsurg.2011.02.003 -
Acta Cirurgica Brasileira 2008To study the effects of peritoneal lavage with a 2% lidocaine solution, on the survival of the rats submitted to peritonitis caused by their own feces.
PURPOSE
To study the effects of peritoneal lavage with a 2% lidocaine solution, on the survival of the rats submitted to peritonitis caused by their own feces.
METHODS
Forty-eight Wistar rats, weighting between 300 g and 330 g (mean, 311,45 +/-9,67 g), were submitted to laparotomy 6 hours following induction of fecal peritonitis. Animals were randomly divided into four groups of 12 each as follows: 1- Control, no therapy; 2- Drying of the abdominal cavity; 3- Peritoneal lavage with saline and drying; 4- Peritoneal lavage with a 2% lidocaine solution and drying. Animals that died were submitted to necropsy and the time of their death recorded; survivors were killed on the post-operation 11th day and necropsied.
RESULTS
Death occurred within 52 h in all animals of group 1; within 126 h in 100% of those of group 2; within 50 h in 50% of those of group 3. All animals of group 4 survived. Survival on the 11 th day was higher in groups 3 and 4 than in groups 1 and 2 (p<0.001), and higher in group 4 than in group 3 (p<0.01).
CONCLUSION
Peritoneal lavage with a 2% lidocaine saline solution without adrenaline, prevented the mortality of all animals with fecal peritonitis.
Topics: Anesthetics, Local; Animals; Anti-Inflammatory Agents; Disease Models, Animal; Drug Evaluation, Preclinical; Feces; Lidocaine; Peritoneal Lavage; Peritonitis; Random Allocation; Rats; Rats, Wistar; Sodium Chloride
PubMed: 18278392
DOI: 10.1590/s0102-86502008000100008 -
Injury 1992The aim of this study was to ascertain whether qualitative assessment could accurately determine a concentration of 100,000 RBC/mm3 in simulated peritoneal lavage fluid....
The aim of this study was to ascertain whether qualitative assessment could accurately determine a concentration of 100,000 RBC/mm3 in simulated peritoneal lavage fluid. The results show that the qualitative methods used are inaccurate and do not reliably predict a red cell concentration of 100,000 per mm3. We therefore recommend that the red cell concentration of peritoneal lavage fluid is always measured before the result is considered 'positive'.
Topics: Abdominal Injuries; Clinical Competence; Erythrocyte Count; Humans; Peritoneal Cavity; Peritoneal Lavage; Wounds, Nonpenetrating
PubMed: 1618571
DOI: 10.1016/s0020-1383(05)80014-2 -
The American Surgeon Jul 1988Despite the advent of sophisticated diagnostic technology the diagnosis of the surgical abdomen in the Intensive Care Unit continues to pose a problem for the surgeon. A...
Despite the advent of sophisticated diagnostic technology the diagnosis of the surgical abdomen in the Intensive Care Unit continues to pose a problem for the surgeon. A retrospective analysis was carried out to evaluate the utility of diagnostic peritoneal lavage to diagnose intra-abdominal surgical disease. Diagnostic peritoneal lavage was carried out in patients in whom the physical exam was deemed unreliable, such as in patients with cardiopulmonary instability or mental obtundation. Patients were included in the study if autopsy or laparotomy confirmation of the lavage data was available. Forty four patients met the inclusion criteria and formed the basis of this study. Of the twenty three patients with a positive lavage, three false-positive diagnostic peritoneal lavages were discovered, either at laparotomy or postmortem exam. Of the twenty one patients where diagnostic peritoneal lavage was negative, no false-negatives were discovered at autopsy or laparatomy. Therefore, this test is 100 per cent sensitive and 88 per cent specific. It is concluded that a negative diagnostic peritoneal lavage makes intra-abdominal surgical disease highly unlikely. However, a positive lavage may require further diagnostic work-up.
Topics: Abdomen; Autopsy; False Positive Reactions; Humans; Infections; Laparotomy; Peritoneal Lavage; Retrospective Studies
PubMed: 3389596
DOI: No ID Found -
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue =... Feb 2004To observe the effects of peritoneal lavage with povine-iodine on prevention of sepsis after exposure of peritoneal cavity to sea water in rat. (Comparative Study)
Comparative Study
OBJECTIVE
To observe the effects of peritoneal lavage with povine-iodine on prevention of sepsis after exposure of peritoneal cavity to sea water in rat.
METHODS
Eighty-four SD rats were randomly divided into two groups, and the peritoneal cavity was exposed to sea water. Rats in group A were not treated (group A, n=42), and the peritoneal cavity was lavage with povine-iodine in group B (n=42). Plasma levels of endotoxin and tumor necrosis factor (TNF) were measured preimmersion, and 0, 12, 24 hours after seawater immersion (n=6), and positive incidence of blood bacterial culture was performed (n=18 in each group) in groups A and B.
RESULTS
1. Plasma levels of endotoxin and TNF in group A and B were increased significantly after exposure of peritoneal cavity to sea water (compared with baseline values, all P<0.05). Plasma levels of endotoxin and TNF in group B became lower than those in group A from 12 hours after seawater immersion (P<0.05 or P<0.01). 2. Positive incidence of bacterial culture in group B was 16.7 % (3/18) and it was lower than that in group A (77.8 % (14/18), P<0.01).
CONCLUSION
Povine-iodine lavage in the peritoneal cavity can reduce levels of plasma endotoxin and TNF, and lower positive incidence of bacterial culture in rats after exposure of peritoneal cavity to sea water, thereby preventing the development of postoperative sepremia.
Topics: Animals; Anti-Infective Agents, Local; Disease Models, Animal; Iodine; Male; Peritoneal Cavity; Peritoneal Lavage; Postoperative Complications; Random Allocation; Rats; Rats, Sprague-Dawley; Seawater; Sepsis; Surgical Wound Infection; Treatment Outcome
PubMed: 14764228
DOI: No ID Found