[Secondary peritonitis and volume therapy - single-site retrospective analysis]

Area of Science:

• Surgical intensive care medicine
• Critical care medicine
• Resuscitation science

Background:

• Secondary peritonitis is a common surgical intensive care unit (ICU) scenario.
• Fluid leakage into interstitial and peritoneal spaces necessitates robust fluid resuscitation for hemodynamic stability.
• Optimizing fluid therapy is crucial for managing patients with peritonitis.

Purpose of the Study:

• To determine specific fluid volumes required for resuscitation in acute peritonitis.
• To analyze volume therapy retrospectively in patients with secondary peritonitis.
• To provide data for improved fluid management strategies in peritonitis.

Main Methods:

• Retrospective analysis of 139 patients with severe secondary peritonitis (2013-2016).
• Volume therapy administered using balanced crystalloids.
• Hemodynamic monitoring included pulse waveform variations and fluid challenge response.

Main Results:

• Mean cumulative positive fluid balance of 8643 ml was associated with hemodynamic stabilization.
• Lethality was 24%, with a mean ICU stay of 8 days.
• Norepinephrine support was required in 42% of patients.

Conclusions:

• Peritonitis causes substantial third-space fluid shifts, demanding significant fluid therapy during resuscitation.
• Underestimation of fluid therapy needs is a practical risk in peritonitis management.
• Adequate fluid optimization is paramount in sepsis and septic shock secondary to peritonitis.