Laparotomy for intra-abdominal sepsis in patients in an intensive care unit

Patients in an intensive care unit who have intra-abdominal (IA) infections producing clinical deterioration in their conditions require urgent intervention. However, detection is often difficult. To define preoperative criteria for, and improve the specificity of, laparotomy, we reviewed 100 explorations in 71 patients with suspected IA sepsis. Eighty-one explorations demonstrated an infected or ischemic process; 19 were negative. Preoperative features associated with a positive laparotomy were as follows: (1) objective evidence by physical examination, ultrasonography, or computed tomography suggesting an IA focus (89%); (2) septic shock (80%); and (3) positive blood cultures (95%). Absence of these features significantly lowered the accuracy of exploration. Septic shock or bacteremia had a 90% mortality regardless of findings at exploration. The best accuracy (89%) and survival (51%) rates were achieved with "directed" exploration before septic shock or bacteremia. Early use of sensitive detection techniques that permit directed laparotomy before septic deterioration should improve survival.