Modified, bicarbonate-augmented direct peritoneal resuscitation for refractory acidosis after damage control laparotomy: a single-center case series.

INTRODUCTION

Despite the utilization of damage control laparotomy (DCL) in acute care surgery, refractory acidosis remains a formidable challenge. This retrospective case series describes our experience with modified direct peritoneal resuscitation (DPR) with sodium bicarbonate in conjunction with DCL as an adjunct for refractory acidosis.

METHODS

We present a retrospective case series of nine adult patients from one tertiary care center following DCL with refractory acidosis treated with DPR using 1.5% peritoneal dialysate with 300 mEq of sodium bicarbonate per 2 L bag.

RESULTS

The change in patients' pre-intervention vs 24-hour post-intervention pH was significant, 0.25 (95% CI 0.011 to 0.392; p=0.031). The change in lactic acid at 24 hours was also significant at -10.2 (mmol/L) (95% CI -16.9 to -3.6; p=0.016). Changes in norepinephrine doses trended down, but did not reach statistical significance.

CONCLUSION

Further investigation of DPR with sodium bicarbonate for managing refractory acidosis in patients who undergo DCL is warranted.