title: Randomized Controlled Trial Evaluating the Efficacy of Peritoneal Resuscitation in the Management of Trauma Patients Undergoing Damage Control Surgery.
abstract: BACKGROUND
  Peritoneal resuscitation (PR) represents a unique modality of treatment for severely injured trauma patients requiring damage control surgery. These data represent the outcomes of a single institution randomized controlled trial into the efficacy of PR as a management option in these patients.
  
  
  METHODS
  From 2011 to 2015, one hundred and three patients were enrolled in a prospective randomized controlled trial evaluating the use of PR in the treatment of patients undergoing damage control surgery compared with conventional resuscitation (CR) alone. Patient demographics, clinical variables, and outcomes were collected. Univariate and multivariate analysis was performed with a priori significance at p ≤ 0.05.
  
  
  RESULTS
  After initial screening, 52 patients were randomized to the PR group and 51 to the CR group. Age, sex, initial pH, and mechanism of injury were used for randomization. Method of abdominal closure was standardized across groups. Time to definitive abdominal closure was reduced in the PR group compared with the CR group (4.1 ± 2.2 days vs 5.9 ± 3.5 days; p ≤ 0.002). Volume of resuscitation and blood products transfused in the initial 24 hours was not different between the groups. Primary fascial closure rate was higher in the PR group (83% vs 66%; p ≤ 0.05). Intra-abdominal complications were lower in the PR compared with the CR group (8% vs 18%), with abscess formation rate (3% vs 14%; p < 0.05) being significant. Patients in the PR group had a lower 30-day mortality rate, despite similar Injury Severity Scores (13% vs 28%; p = 0.06).
  
  
  CONCLUSIONS
  Peritoneal resuscitation enhances management of damage control surgery patients by reducing time to definitive abdominal closure, intra-abdominal infections, and mortality rates.
authors.affiliation: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY. Electronic address: jasonw.smith@louisville.edu.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY; Louisville Veterans Affairs Medical Center, Louisville, KY.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Matheson
authors.affiliation: Department of Surgery, University of Louisville, Louisville, KY; Louisville Veterans Affairs Medical Center, Louisville, KY.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.affiliation: Louisville Veterans Affairs Medical Center, Louisville, KY.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Harbrecht
authors.affiliation: Louisville Veterans Affairs Medical Center, Louisville, KY.
authors.forename: J David
authors.initials: JD
authors.lastname: Richardson
authors.affiliation: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY; Louisville Veterans Affairs Medical Center, Louisville, KY.
authors.forename: R Neal
authors.initials: RN
authors.lastname: Garrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*