Determinants of mortality due to secondary peritonitis in the Teaching General Hospital ¨Dr. Agostinho Neto¨, Guantanamo
Keywords:
peritonitis, intensive care unit, acute abdomen surgeryAbstract
Introduction: the factors that determine the prognosis of the patient with peritonitis are not always known in the intensive care unit. Objective: to determine the determinants of mortality due to secondary peritonitis in this unit at the Hospital "Dr. Agostinho Neto during the years 2014 - 2016. Method: a prospective, longitudinal, and analytical study was conducted of all the patients admitted to the ICU for secondary peritonitis in the years 2014 - 2016 (n = 70), which were grouped according to graduates alive or deceased. The variables most related to the probability of the patient's death and the most frequent in the deceased were specified. The absolute risk (AR) of each variable was calculated. Results: the most frequent factors were: fever (n = 53), systemic inflammatory response syndrome (n = 51) and left leukocytosis / deviation (n = 51); the factors most likely to determine death were multiorgan failure (RA 17.8), fecaloid peritoneal fluid (RA 7.8) and septic shock (RA 7.3). Conclusion: The factors that determine mortality due to secondary peritonitis: diffuse peritonitis, presence of multi-organ failure, hypoxemia ≤ 85 mmHg / or Sp02 ≤ 90%, age ≥ 60 years, intra-abdominal pressure after surgery ≥ 21 cm H2O (15 mmHg) , symptoms ≥ 24 h before surgery, septic shock, fecaloid peritoneal fluid, colonic origin of peritonitis.
Downloads
References
2. Rodríguez C, Arce Aranda C, Samaniego C. Peritonitis aguda secundaria. Causas, tratamiento, pronóstico y mortalidad. Rev Cir Parag [Internet]. 2014 Ago [citado 2017 Sep 8]; 38(1): [aprox. 7 p.]. Disponible en: http://scielo.iics.una.py/scielo.php?pid=S2307-04202014000100004&script=sci_arttext
3. Malbrain ML, Chiumello D, Pelosi P, et al: Prevalence of intra-abdominal hypertension in critically ill patients: a multicenter epidemiological study. Intensive Care Med. 2010; 30: 822-9.
4. Balogh Z, McKinley BA, Cocanour CS, et al: Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg. 2012; 184: 538-43.
5. Morales IA, Delgado A, Pérez L. Sepsis intraabdominal: análisis de 119 operados en 10 años Rev Cubana Cir. 2009;48(4):12-17.
6. Lombardo Vaillant TA, Reyes Ávalos N, Soler Morejón C, Lombardo Vaillant J, Fiol Zulueta A. Valor predictivo del índice de peritonitis de Mannheim en pacientes con colecistitis aguda. Rev Cubana Med Mil [Internet]. 2010 Mar [citado 3 Sep 2017];9(1): [aprox. 6 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=
S0138-65572010000100002&lng=es
7. Ruiz Ferrón F, Tejero Pedregosa A, Ruiz García M, Ferrezuelo Mata A, Pérez Valenzuela J, Quirós Barrera R, et al. Presión intraabdominal y torácica en pacientes críticos con sospecha de hipertensión intraabdominal. Med Intens [Internet]. 2011 Jul [citado 3 Sep 2017];35(5):274-279. Disponible en: http://scielo.isciii.es/scielo. php? script= sci_arttext&pid=S0210-56912011000500003&lng=es
8. Scheuerlein H, Kube R, Gastinger J, Kocherling F. Prospective multicenter comparative study of management of peritonitis. Zentralbl Chir. 2010; 125 (2): 199-204.
9. Berreta J, Kociak D, Balducci A,Balducci A, De Feo F, Laplacette MV, Bellido F. et al. Peritonitis secundaria generalizada: Predictores de mortalidad y sobrevida y vinculantes evolutivos de mortalidad. Acta Gastroenterol Latinoam. 2010; 40: 105-116.
10. Balogh Z, McKinley BA, Holcomb JB. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2013; 54: 848-59.
11. Lamme BMA, Belt EJ. Mortality and morbidity of laparotomy versus relaparotomy on demand for secondary peritonitis. Br J Surg. 2013;91(8):1046-54.
12. Singh R, Kumar N. Preoperative Predictors of Mortality in Adult Patients with Perforation Peritonitis. Indian J Critical Care [Internet]. 2011 Jul [citado 2017 Sep 8];15(3):157-163. Disponible en: http://www.bago.com/BagoArg/Biblio/cirugweb308.htm
13. Iñaguazo SD, Astudillo MJ. Abdomen abierto en la sepsis intraabdominal severa. Rev Chilena Cir. 2009;61(3):294-300.
14. Kumar S, Gupta A, Chaudhary S, Agrawal N. Validation of the use of POSSUM score in enteric perforation peritonitis. Pan Afr Med J [Internet]. 2011 Jun 23 [cited 2017 Oct 23];9:24-30. Disponible en: http://www.ncbi.nlm.nih.gov pmc/articles/PMC3215544/
15. Fuentes Díaz Z. Modelos multidimensionales pronósticos de mortalidad quirúrgica en intervenciones electivas no cardiacas. [Tesis]. Camagüey: Universidad Carlos J. Finlay; 2014. Disponible en: http://tesis.repo.sld.cu/866/1/Zaily_Fuentes_Diaz.pdf
16. Betancourt Cervantes JR, Martínez Ramos G, Sierra Enríquez E, López de la Cruz F, Gonzáles Delis R. Relaparotomías de urgencias: evaluación en cuatro años. Rev Cubana Med Mil [Internet]. 2003 [citado 20 Jun 2017];32(4):25-31. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572003000400008&lng=es&nrm=iso&tlng=es
17. Kologlu M, Elker D, Altun H, Sayek I. Validation of MPI and PIA II in two different groups of patients with secondary peritonitis. Hepatogastroenterology. 2001;48(37):147-51.
18. Rodríguez R. Causas, tratamiento y complicaciones de la peritonitis difusa en un hospital de Luanda. MEDISAN. 2010;14(8):1076.
19. Núñez Martinez JF, Almeida Alfonso MH, Gómez Castellanos R, Madruga Vásquez C, Jorrin. Brito Y, Flores González I. Determinación de la presión intraabdominal en la evolución postoperatoria de la cirugía abdominal. Rev Cubana Med Int Emerg [Internet]. 2011 Jul [citado 2017 Sep 8];14(3):28-41. Disponible en: http://www.revmie.sld.cu/determinación_de_la_presión.pdf
