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Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room

INTRODUCTION: The prognoses of critically ill patients with a requirement for emergency laparotomy and severe respiratory and/or hemodynamic instability precluding transport to the operating room (OR) are often fatal without surgery. Attempting emergency surgery at the bedside might equally result i...

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Autores principales: Schreiber, Joerg, Nierhaus, Axel, Vettorazzi, Eik, Braune, Stephan A, Frings, Daniel P, Vashist, Yogesh, Izbicki, Jakob R, Kluge, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231096/
https://www.ncbi.nlm.nih.gov/pubmed/24935653
http://dx.doi.org/10.1186/cc13925
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author Schreiber, Joerg
Nierhaus, Axel
Vettorazzi, Eik
Braune, Stephan A
Frings, Daniel P
Vashist, Yogesh
Izbicki, Jakob R
Kluge, Stefan
author_facet Schreiber, Joerg
Nierhaus, Axel
Vettorazzi, Eik
Braune, Stephan A
Frings, Daniel P
Vashist, Yogesh
Izbicki, Jakob R
Kluge, Stefan
author_sort Schreiber, Joerg
collection PubMed
description INTRODUCTION: The prognoses of critically ill patients with a requirement for emergency laparotomy and severe respiratory and/or hemodynamic instability precluding transport to the operating room (OR) are often fatal without surgery. Attempting emergency surgery at the bedside might equally result in an adverse outcome. However, risk factors and predictors that could support clinical decision making have not been identified so far. This study describes the clinical characteristics, indicative pathophysiology and outcomes in patients undergoing resuscitative laparotomy in the intensive care unit (ICU). METHODS: This was a retrospective observational study of all critically ill adult patients undergoing resuscitative laparotomy in the ICUs of a German university hospital from January 2005 to July 2013. Clinical characteristics, risk factors, and treatments were compared between survivors and non-survivors. The primary endpoint was 28-day survival. RESULTS: A total of 41 patients with a median age of 64 (21 to 83) were included. The most frequent reasons for ICU admission were sepsis, pneumonia, and pancreatic surgery. All patients were mechanically ventilated, receiving vasopressors, and were in multiple organ failure. Twenty-nine patients (70.7%) were on renal replacement therapy and two patients (4.9%) on extracorporeal membrane oxygenation. The main reasons for surgery were suspected intra-abdominal bleeding (39.0%), suspected intestinal ischemia (24.4%) or abdominal compartment syndrome (24.4%). Twenty-eight-day, ICU and hospital mortalities were 75.6%, 80.5%, and 82.9%, respectively. In six out of ten patients (60%) who survived surgery for more than 28 days, bedside laparotomy was rated as a life-saving procedure by an interdisciplinary group of the investigators. CONCLUSIONS: These findings suggest that in selected critically ill patients with a vital indication for emergency laparotomy and severe cardiopulmonary instability precluding transport to the OR, a bedside resuscitative laparotomy in the ICU can be considered as a rescue procedure, even though very high mortality is to be expected.
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spelling pubmed-42310962014-11-14 Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room Schreiber, Joerg Nierhaus, Axel Vettorazzi, Eik Braune, Stephan A Frings, Daniel P Vashist, Yogesh Izbicki, Jakob R Kluge, Stefan Crit Care Research INTRODUCTION: The prognoses of critically ill patients with a requirement for emergency laparotomy and severe respiratory and/or hemodynamic instability precluding transport to the operating room (OR) are often fatal without surgery. Attempting emergency surgery at the bedside might equally result in an adverse outcome. However, risk factors and predictors that could support clinical decision making have not been identified so far. This study describes the clinical characteristics, indicative pathophysiology and outcomes in patients undergoing resuscitative laparotomy in the intensive care unit (ICU). METHODS: This was a retrospective observational study of all critically ill adult patients undergoing resuscitative laparotomy in the ICUs of a German university hospital from January 2005 to July 2013. Clinical characteristics, risk factors, and treatments were compared between survivors and non-survivors. The primary endpoint was 28-day survival. RESULTS: A total of 41 patients with a median age of 64 (21 to 83) were included. The most frequent reasons for ICU admission were sepsis, pneumonia, and pancreatic surgery. All patients were mechanically ventilated, receiving vasopressors, and were in multiple organ failure. Twenty-nine patients (70.7%) were on renal replacement therapy and two patients (4.9%) on extracorporeal membrane oxygenation. The main reasons for surgery were suspected intra-abdominal bleeding (39.0%), suspected intestinal ischemia (24.4%) or abdominal compartment syndrome (24.4%). Twenty-eight-day, ICU and hospital mortalities were 75.6%, 80.5%, and 82.9%, respectively. In six out of ten patients (60%) who survived surgery for more than 28 days, bedside laparotomy was rated as a life-saving procedure by an interdisciplinary group of the investigators. CONCLUSIONS: These findings suggest that in selected critically ill patients with a vital indication for emergency laparotomy and severe cardiopulmonary instability precluding transport to the OR, a bedside resuscitative laparotomy in the ICU can be considered as a rescue procedure, even though very high mortality is to be expected. BioMed Central 2014 2014-06-16 /pmc/articles/PMC4231096/ /pubmed/24935653 http://dx.doi.org/10.1186/cc13925 Text en Copyright © 2014 Schreiber et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Schreiber, Joerg
Nierhaus, Axel
Vettorazzi, Eik
Braune, Stephan A
Frings, Daniel P
Vashist, Yogesh
Izbicki, Jakob R
Kluge, Stefan
Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room
title Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room
title_full Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room
title_fullStr Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room
title_full_unstemmed Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room
title_short Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room
title_sort rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231096/
https://www.ncbi.nlm.nih.gov/pubmed/24935653
http://dx.doi.org/10.1186/cc13925
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