Application of Damage Control tactics in the treatment of patients with generalized peritonitis and septic shock

Abstract

INTRODUCTION. Patients with peritonitis complicated by severe sepsis and septic shock determine the mortality rate of a general surgical hospital. The role and place of the Damage control technique in this category of patients remain debatable.The OBJECTIVE was to analyze the use of tactics of staged surgical treatment in patients with peritonitis and septic shock.METHODS AND MATERIALS. On the base of the Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, we conducted a prospective randomized study of the effectiveness of various approaches to the treatment of patients with non-traumatic peritonitis and septic shock, who, after elimination of the primary source, need to restore intestinal continuity. The study included 37 patients, their mean age was (69±14) years, women were 19 (51 %). The patients were divided into 2 groups: the study group (n=14) included patients treated with the Damage Control (DC) principle, in the comparison group (n=23), primary surgery was performed in full. Both groups are representative in terms of demographics, comorbidity, severity of peritonitis and organ dysfunction.RESULTS. The groups differed significantly in the duration of preoperative preparation (p=0.028) and surgery (p=0.025). Mortality rate among patients who used DC tactics was 2 times lower (35.6 vs. 73.9 %) (p=0.038). When assessing the indicators of systemic hypoperfusion, a difference was noted in the dynamics of lactate (p=0.048) and INR (p=0.007) values during the first three days of the postoperative period. Accordingly, in patients who underwent staged treatment, there was a positive dynamics in SOFA values (p=0.049) from the 3rd day, and by the 7th day of the postoperative period in most patients, this indicator did not exceed 2 points (p=0.048). During staged surgical treatment, a constant increase in the Horvitz index was recorded from the second day of the postoperative period, while in the control group, the dynamics of this indicator was negative (p=0.041).СONCLUSIONS. Damage control tactics is safe and can be used in the treatment of general surgical patients with non-traumatic peritonitis and septic shock. Reducing the duration of preoperative preparation, reducing the volume of surgical intervention and, consequently, the duration of the operation allow reduce the time for eliminating signs of systemic hypoperfusion and organ dysfunction, which reduces the rate of death.