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[The role of the surgeon in treating multiple organ failure]
Abstract:
Over the period 1990 through 1995, thirty-five patients with multiorgan insufficiency (MOI) undergo treatment. Abdominal operations are performed in all of them, except for one male patient aged 31 years, dying of bilateral pneumonia and metabolic disorders resulting from duodenal stenosis. Overall mortality rate amounts to 77 per cent (20 cases). Programmed peritoneal lavage (PPL) is done in seventeen patients with lethality 77 per cent (13 cases). In two instances iatrogenic damage to the spleen contribute to fatal septic complications development. All PPL treated patients with fatal outcome have bilateral pneumonia. MOI prevention is still closely linked to prophylaxis against the complications producing it. Programmed peritoneal lavage in immunocompromised and malnourished patients is a risk factor equally serious as the septic noxa being attacked, and what is more it runs the risk of inflicting additional iatrogenic noxae. General endotracheal anesthesia in PPL is likewise a factor demanding further clarification.
Insights
Multiorgan insufficiency (MOI) treatment involving abdominal operations and programmed peritoneal lavage (PPL) showed a high 77% mortality rate. PPL posed significant risks, especially in immunocompromised patients, contributing to fatal outcomes.
Area of Science:
- Critical care medicine
- Surgical intensive care
Context:
- Multiorgan insufficiency (MOI) presents complex therapeutic challenges.
- Abdominal operations were a common intervention for MOI patients between 1990-1995.
Purpose:
- To evaluate the outcomes of MOI patients treated with abdominal operations and programmed peritoneal lavage (PPL).
- To identify risk factors and complications associated with MOI treatment.
Summary:
- Thirty-five MOI patients underwent treatment, with 77% mortality. Programmed peritoneal lavage (PPL) was performed on 17 patients, resulting in a 77% lethality rate.
- Fatal outcomes in PPL patients were often associated with bilateral pneumonia.
- Iatrogenic complications, such as spleen damage, contributed to septic complications and mortality.
Impact:
- Programmed peritoneal lavage (PPL) is identified as a significant risk factor in immunocompromised and malnourished MOI patients.
- The study highlights the need for improved MOI prevention strategies and careful consideration of PPL risks.
- General endotracheal anesthesia during PPL requires further investigation regarding its impact on patient outcomes.