This session demonstrates Direct Peritoneal Resuscitation (DPR) for patients with a temporary abdominal closure. DPR can help improve outcomes for open abdomen patients, reduce time to closure, increase rates of facial closure, and reduce the risk of fistula formation.
Direct Peritoneal Resuscitation has been used for open abdomen patients to help preserve microcirculation by reversing vasoconstriction and hypoperfusion associated with the pathophysiological process of shock, which can occur despite appropriate intravenous resuscitation. This approach depends on infusing a hyperosmolar solution intraperitoneally via a percutaneous catheter with the tip ending near the pelvis or the root of the mesentery. The abdomen is usually left open with an AbThera negative pressure abdominal dressing to continuously evacuate the infused dialysate. Hypertonicity of the solution triggers visceral vasodilation to help maintain blood flow, even during shock, and is also associated with reduced local inflammatory cytokines and other mediators, preservation of endothelial cell function, and mitigation of organ edema and necrosis. It also has a direct effect on liver perfusion and edema, more rapidly corrects electrolyte abnormalities compared to intravenous resuscitation alone, and may require less intravenous fluid to stabilize blood pressure.
References:
Smith, J.W., Garrison, N., Matheson, P.J. Harbrecht, B.G., Benns, M.V., Franklin, G.A., Miller, K.R., Bozeman, M.C. & Richardson, J.D. (2013). Adjunctive treatment of abdominal catastrophes and sepsis with direct peritoneal resuscitation: Indications for use in acute care surgery. Trauma Acute Care Surgery. 77(3), 393-399.
Smith, J.W., Garrison, N., Matheson, P.J. Harbrecht, B.G., Benns, M.V., Franklin, G.A., Miller, K.R., Bozeman, M.C. & Richardson, J.D. Direct peritoneal resuscitation accelerates primary abdominal wall closure after damage control surgery. Journal of the American College of Surgeons. 210(5), 658-667.
Weaver, J.L., Smith, J.W. (2016). Direct Peritoneal Resuscitation: A review. International Journal of Surgery. 33(2016), 237-241.
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