Elías SR, Fernández LJO, Choo UT, Bordelois AMS, Lecourtois ML

Language: Spanish
References: 16
Page: 1-12
PDF size: 425.73 Kb.

ABSTRACT

Introduction: Determining the prognosis of the patient with secondary diffuse peritonitis is a challenge for surgeons and intensivists.
Objective: To identify the factors related to the risk of multiple organ failure in patients with secondary diffuse peritonitis admitted to the intensive care unit of the Hospital “Dr. Agostinho Neto”.
Methods: A case study (patients with peritonitis and multi-organ failure n = 68) and controls (patients with peritonitis without multi-organ failure n = 47), in the period 2017-2018, was performed. 64 variables that characterized the patient or peritonitis were analyzed, and their association with the risk of the patient to present multiple organ failure was calculated.
Results: The variables most associated with this risk were: anesthetic risk 3 or more according to the American Society of Anesthesia classification (odds ratio = 47.7), acid-basic / electrolyte imbalance (odds ratio = 22.6), hyperglycemia 10 mmol / l or more in non-diabetics (odds ratio = 15.5), persistent reflex paralytic ileus (odds ratio = 13.6), respiratory distress (odds ratio = 11.8), use of invasive mechanical ventilation (odds ratio = 11.8), Sequential [Sepsis-Related] Organ Failure Assessment 4 points or more (odds ratio = 10.2), treatment with open abdomen (odds ratio = 9.0), Acute Physiology and Chronic Health Evaluation II scale 15 15 points or more (odds ratio = 8.9), septic shock (odds ratio = 8.6).
Conclusions: The factors associated with the presentation of multi-organ failure were identified, which made possible the design of a predictive scale of this failure in the patient with secondary diffuse peritonitis.

REFERENCES

1. Elías SR, Porro AC, Guindo GV, Esteban SJ. Mortalidad por peritonitis secundaria en terapia intensiva. Rev Cub Cir. 2018 [acceso 12/08/2019];7(4). Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/732/352

2. Rodríguez AET, González AJC, Cabrera LJO, Algas HLA. Factores pronósticos de fallo orgánico y muerte en pacientes con peritonitis difusa secundaria. Rev Cub Med Int Emerg. 2018 [acceso 12/08/2019];17(4):1-18. Disponible en: http://www.revmie.sld.cu/index.php/mie/article/view/424/html_187

3. Nakagoe T, Miyata H, Gotoh M, Anazawa T, Baba H, Kimura W, et al. Surgical risk model for acute diffuse peritonitis based on a Japanese database. Surg Today. 2015 [acceso 12/08/2019];45(10):1233-43. Disponible en: https://link.springer.com/article/10.10072Fs00595-014-1026-x

4. Vintimilla A, Molina S, Merchán M. Validación del Índice Pronóstico de Mannheim en pacientes con peritonitis secundaria. Rev Médica HJCA. 2017 [acceso 12/08/2019];4(1):14–8. Disponible en: http://revistamedicahjca.med.ec/ojs/index.php/ RevHJCA/article/view/279/266

5. Colsa GP. Factores de riesgo de morbimortalidad tras cirugía abdominal urgente en pacientes mayores de 70 años. [Tesis doctoral]. España: Universidad de Cantabria. 2016 Jul [acceso 12/08/2019]. Disponible en: https://www.tdx.cat/bitstream/handle/10803/402900/TesisPCG.pdf?sequence=1

6. Gascón FI. Índices pronósticos en las peritonitis secundarias comunitarias de origen colónico. [Tesis doctoral]. España: Universidad de Zaragoza. 2016 [acceso 12/08/2019]. Disponible en: https://zaguan.unizar.es/record/56346/files/TESIS-2016-171.pdf

7. Godínez VA, García VD, Montero GPJ, Martínez MAR, Gutiérrez BCA, Gracida MNI, et al. Utilidad del índice SOFA en sepsis abdominal por peritonitis secundaria Rev Hosp Jua Mex. 2018 [acceso 12/08/2019];85(4):195-200. Disponible en: https://www.researchgate.net/publication/329876932_utilidad_del_indice_SOFA_en_ sepsis_abdominal_por_peritonitis_secundaria

8. Salamone G, Licari L, Falco N, Augello G, Tutino R, Campanella S, et al. Mannheim Peritonitis Index and elderly population: prognostic evaluation in acute secondary peritonitis. G Chir. 2016 [acceso 12/08/2019];37(6):243-9. Disponible en: https://dx.doi.org10.11138/gchir/2016.37.6.243

9. Ciuró MF, Gómez MJ. Peritonitis secundaria y terciaria – Guía PRIOAM. 2018 [acceso 12/08/2019]. Disponible en: http://guiaprioam.com/indice/peritonitis-2/

10. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017 [acceso 12/08/2019];45:486–552. Disponible en: https://doi.org/10.1097/CCM.0000000000002255.

11. Dominguez YR, Esteban SJA, Ramírez NE. Mortalidad por peritonitis secundaria. Rev Inf Cient. 2018 Ene [acceso 12/08/2019];97(1):67-75. Disponible en: http://www.revinfcientifica.sld.cu/index.php/ric/article/view/1816/3504

12. Verma R, Gupta D. Clinical study of prognostic factors in perforative peritonitis. IJBAMR. 2017 [acceso 12/08/2019];7(1):601-6. Disponible en: http://ijbamr.com/pdf/December/2017/601-606.pdf

13. Ballus NJ. Factores de riesgo y mortalidad a corto plazo en pacientes con peritonitis secundaria y terciaria. [Tesis doctoral]. España: Universidad Autónoma de Barcelona. 2016 Jul [acceso 12/08/2019]. Disponible en: https://ddd.uab.cat/pub/tesis/2016/hdl_10803_381090/jbn1de1.pdf

14. Launey Y, Duteurtre B, Larmet R, Nesseler N, Tawa A, Mallédant Y, et al. Risk factors for mortality in postoperative peritonitis in critically ill patient. World J Crit Care Med. 2017 Feb [acceso 12/08/2019];6(1):48-55. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295169/pdf/WJCCM-6-48.pdf

15. Benítez E, Galli V, Jara J, Miranda A, Morel J, Olazar L, et al. Complicaciones y mortalidad por peritonitis. Medicina Clínica y Social. 2018 [acceso 12/08/2019];2(1). Disponible en: http://www.medicinaclinicaysocial.org/index.php/MCS/article/view/43

16. Van Ruler O, Boermeester MA. Surgical treatment of secondary peritonitis. A continuing problem. Chirurg. 2017 [acceso 12/08/2019];88(Suppl1):S1–S6. Disponible en: https://link.springer.com/content/pdf/10.1007/s00104-015-0121-x.pdf