• Annals of surgery · Dec 2006

    Prediction of postoperative complications after urgent laparotomy by intraperitoneal microdialysis: A pilot study.

    • Colin L Verdant, Marialuisa Chierego, Véronique De Moor, Reza Chamlou, Jacques Creteur, Jean de Dieu Mutijima, Patricia Loi, Michel Gelin, Antonino Gullo, Jean-Louis Vincent, and Daniel De Backer.
    • Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
    • Ann. Surg. 2006 Dec 1; 244 (6): 9941002994-1002.

    ObjectiveThe aim of the present study was to investigate the role of intraperitoneal microdialysis (IPM) techniques in monitoring the evolution of postoperative critically ill patients requiring urgent laparotomy.Summary Background DataPostoperative intraabdominal sepsis is associated with an important degree of morbidity and mortality in acutely ill patients. Early diagnosis is critical to improve outcomes.Methods: The study included 25 consecutive patients admitted to the intensive care unit (ICU) after urgent laparotomy. Measurements of microdialysate fluid were performed through a microdialysis catheter, positioned intraperitoneally, during the first 5 postoperative days and lactate/pyruvate (L/P) ratios calculated. Patients were followed until hospital discharge.ResultsTen patients had a complicated postoperative course, including 4 deaths (3 refractory shock, 1 mesenteric ischemia), 3 reinterventions (1 necrotic collection, 1 mesenteric ischemia, 1 biliary leak), 2 secondary peritonitis, and 1 intraabdominal collection. The IPM L/P ratio in these patients was already significantly higher during the first 24 postoperative hours compared with patients who had no complications (35 +/- 21 vs. 18 +/- 6, P < 0.01). An IPM L/P ratio above 22 on postoperative day 1 had a sensitivity of 0.64 and a specificity of 0.79 for complications. There were no significant differences between the two groups in pH, lactate, white blood cell count, or subcutaneous L/P ratio. No complication was associated with the technique.ConclusionsIPM is safe and reliable and provides valuable information after urgent laparotomy. Persistently high L/P values should raise the possibility of serious postoperative complications.

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