Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra‐abdominal Infections: A Retrospective Analysis on 111 Cases

Rausei, Stefano; Pappalardo, Vincenzo; Ruspi, Laura; Colella, A. Centi; Giudici, Simone; Ardita, Vincenzo; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

doi:10.1007/s00268-017-4233-y

Cited by 28 publications

(19 citation statements)

References 57 publications

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“…The relative risk for the selected outcome (hospital mortality) in relation to focus clearance is 3.7 (27% for ≥ 6 hours and 9% for < 6 hours). ( 11 ) Thus, the calculated sample size was 164, considering a power of 80% and a significance level of 5%.…”

Section: Methodsmentioning

confidence: 99%

“…The Surviving Sepsis Campaign (SSC) ( 10 ) recommends that all patients be evaluated early for sites of infection amenable to source control (focus clearance). However, the association between time to focus clearance and outcome in patients with sepsis is less studied ( 11 - 13 ) and consequently receives less attention in the literature. In the SSC, ( 10 ) for example, there are nine pages devoted to the discussion of antimicrobial therapy and only one page addressing source control.…”

Section: Introductionmentioning

confidence: 99%

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Time to clearance of abdominal septic focus and mortality in patients with sepsis

Moraes¹,

Serafini²,

Vidart³

et al. 2020

Revista Brasileira De Terapia Intensiva

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Objective To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock. Methods This was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group. Results A total of 135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137. Conclusion There was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Time to clearance of abdominal septic focus and mortality in patients with sepsis

Moraes¹,

Serafini²,

Vidart³

et al. 2020

Revista Brasileira De Terapia Intensiva

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“…Studies have shown that as soon as the infectious foci that cause sepsis and require surgery are confirmed, as in cases of intra-abdominal abscess, gastrointestinal perforation, acute suppurative cholangitis, acute pyelonephritis associated with abscess, intestinal ischemia, empyema or septic arthritis, the immediate control of infectious foci is more important than antibiotic administration for managing infection. [80,84,89–94] In fact, failure to control infectious foci will irreversibly aggravate septic shock. [95] Therefore, source control is fundamental to successful shock resuscitation and is considered emergency surgery for these patients.…”

Section: Right Source Control: Controlling the Source Of Infection Ismentioning

confidence: 99%

Rules of anti-infection therapy for sepsis and septic shock

Zhou

Zhang

et al. 2019

Chinese Medical Journal

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Objective:Sepsis is a deadly infection that causes injury to tissues and organs. Infection and anti-infective treatment are the eternal themes of sepsis. The successful control of infection is a key factor of resuscitation for sepsis and septic shock. This review examines evidence for the treatment of sepsis. This evidence is combined with clinical experiments to reveal the rules and a standard flowchart of anti-infection therapy for sepsis.Data Sources:We retrieved information from the PubMed database up to October 2018 using various search terms and their combinations, including sepsis, septic shock, infection, antibiotics, and anti-infection.Study Selection:We included data from peer-reviewed journals printed in English on the relationships between infections and antibiotics.Results:By combining the literature review and clinical experience, we propose a 6Rs rule for sepsis and septic shock management: right patients, right time, right target, right antibiotics, right dose, and right source control. This rule encompasses rational decisions regarding the timing of treatment, the identification of the correct pathogen, the selection of appropriate antibiotics, the formulation of a scientifically based antibiotic dosage regimen, and the adequate control of infectious foci.Conclusions:This review highlights how to recognize and treat sepsis and septic shock and provides rules and a standard flowchart for anti-infection therapy for sepsis and septic shock for use in the clinical setting.

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“…The patient is taken back to the operating room 48 h later to restore intestinal continuity. Several groups including our institution adopted this systematic 2nd look strategy in unstable patients with abdominal sepsis [36,[41][42][43][44][45][46][47]. In addition to simple visceral coverage, a temporary abdominal closure using negative pressure therapy (NPT) might help clearing pro-inflammatory cytokines and potentially reducing peritoneal and systemic inflammation and thus improving outcomes [9,13,14,[48][49][50][51][52].…”

Section: Introductionmentioning

confidence: 99%

Cytokine clearance in serum and peritoneal fluid of patients undergoing damage control surgery with abdominal negative pressure therapy for abdominal sepsis

Faes

Demartines

Hahnloser

2020

Pleura and Peritoneum

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ObjectivesOpen abdomen technique with negative pressure therapy (NPT) is widely used in patients with severe abdominal sepsis. The aim of this study was to evaluate cytokine clearance in serum and peritoneal fluid during NPT.MethodsThis prospective pilot study included six patients with severe abdominal sepsis requiring discontinuity resection and NPT for 48 h followed by planned reoperation. Cytokines (IL6, IL8, IL10, TNFalpha, and IL1beta) were measured in the serum and peritoneal fluid during index operation, on postoperative days 0, 1, and 2.ResultsConcentrations of cytokines in peritoneal fluid were higher than in serum. IL10 showed a clearance both in serum (to 16.6%, p=0.019) and peritoneal fluid (to 40.9%, p=0.014). IL6 cleared only in serum (to 24.7%, p=0.001) with persistently high levels in peritoneal fluid. IL8 remained high in both serum and peritoneal fluid. TNFalpha and IL1beta were both low in serum with wide range of high peritoneal concentrations. Only TNFalpha in peritoneal fluid showed significant differences between patients with ischemia vs. perforation (p=0.006).ConclusionsThe present pilot study suggests that cytokines display distinct patterns of clearance or persistence in the peritoneal fluid and serum over the first 48 h of treatment in severe abdominal sepsis with NPT.

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Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra‐abdominal Infections: A Retrospective Analysis on 111 Cases

Abstract: Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

Cited by 28 publications

References 57 publications

Time to clearance of abdominal septic focus and mortality in patients with sepsis

Time to clearance of abdominal septic focus and mortality in patients with sepsis

Rules of anti-infection therapy for sepsis and septic shock

Cytokine clearance in serum and peritoneal fluid of patients undergoing damage control surgery with abdominal negative pressure therapy for abdominal sepsis

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