title: Prediction of postoperative complications after urgent laparotomy by intraperitoneal microdialysis: A pilot study.
abstract: OBJECTIVE
  The aim of the present study was to investigate the role of intraperitoneal microdialysis (IPM) techniques in monitoring the evolution of postoperative critically ill patients requiring urgent laparotomy.
  
  
  BACKGROUND
  Postoperative intraabdominal sepsis is associated with an important degree of morbidity and mortality in acutely ill patients. Early diagnosis is critical to improve outcomes.
  
  
  METHODS
  : The study included 25 consecutive patients admitted to the intensive care unit (ICU) after urgent laparotomy. Measurements of microdialysate fluid were performed through a microdialysis catheter, positioned intraperitoneally, during the first 5 postoperative days and lactate/pyruvate (L/P) ratios calculated. Patients were followed until hospital discharge.
  
  
  RESULTS
  Ten patients had a complicated postoperative course, including 4 deaths (3 refractory shock, 1 mesenteric ischemia), 3 reinterventions (1 necrotic collection, 1 mesenteric ischemia, 1 biliary leak), 2 secondary peritonitis, and 1 intraabdominal collection. The IPM L/P ratio in these patients was already significantly higher during the first 24 postoperative hours compared with patients who had no complications (35 +/- 21 vs. 18 +/- 6, P < 0.01). An IPM L/P ratio above 22 on postoperative day 1 had a sensitivity of 0.64 and a specificity of 0.79 for complications. There were no significant differences between the two groups in pH, lactate, white blood cell count, or subcutaneous L/P ratio. No complication was associated with the technique.
  
  
  CONCLUSIONS
  IPM is safe and reliable and provides valuable information after urgent laparotomy. Persistently high L/P values should raise the possibility of serious postoperative complications.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
authors.forename: Colin L
authors.initials: CL
authors.lastname: Verdant
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Chierego
authors.forename: Véronique
authors.initials: V
authors.lastname: De Moor
authors.forename: Reza
authors.initials: R
authors.lastname: Chamlou
authors.forename: Jacques
authors.initials: J
authors.lastname: Creteur
authors.forename: Jean
authors.initials: J
authors.lastname: de Dieu Mutijima
authors.forename: Patricia
authors.initials: P
authors.lastname: Loi
authors.forename: Michel
authors.initials: M
authors.lastname: Gelin
authors.forename: Antonino
authors.initials: A
authors.lastname: Gullo
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010865:Pilot Projects; D011237:Predictive Value of Tests; D019289:Pyruvic Acid / Q000097:blood
chemical_list: D019344:Lactic Acid; D019289:Pyruvic Acid