[Secondary peritonitis and volume therapy - single-site retrospective analysis]. / Sekundární peritonitida a potreba tekutinové lécby - retrospektivní analýza jednoho pracoviste.

ABSTRACT

INTRODUCTION: Secondary peritonitis is a typical surgical intensive care situation. Leakage of fluid into the interstitial space and peritoneal cavity requires adequate fluid resuscitation to optimize the hemodynamic stability. The aim of the study is to present specific volumes of fluid transfer in situations of acute peritonitis based on a single-site retrospective analysis of volume therapy in patients with this condition. METHODS: Retrospective analysis of patients with secondary peritonitis treated at ICU-1 of the Surgical Department of the University Hospital in Hradec Kralove between 20132016. Volume therapy was provided using balanced crystalloids and was monitored based on dynamic hemodynamic indicators (variations of the pulse waveform, response to fluid challenge, physical examination). Fluid balance was managed by intake and output measurements and by estimating immeasurable losses. RESULTS: We evaluated the set of 139 patients with severe secondary peritonitis according to the Mannheim Peritonitis Index (MPI) 27.9 and predicted lethality 26%. The lethality actual was 24%. Hemodynamic stabilization was associated with the mean cumulative positive fluid balance of 8643 ml, which peaked after 1.83 day from admission. The average length of ICU stay was 8 days. Blood pressure support with norepinephrine was necessary in 42% of patients and lasted the mean of 32 hours. None of the patients was on dialysis; in two cases, kidney failure occurred in a situation of generalized cancer and intractable vascular ileus. CONCLUSION: Peritonitis leads to significant leakage of fluids into the third space, and in surgery, it is one of conditions characterized by the highest need of fluid therapy in the resuscitation phase of sepsis and septic shock. The risk of underestimating fluid therapy is high in practice.Key words peritonitis septic shock - fluid optimization positive fluid balance.