Behind the knife
Journal Review in Trauma Surgery: Direct Peritoneal Resuscitation
EP. 672Oct. 30, 202332:40
Trauma
Overview
Direct Peritoneal Resuscitation! We’re not just dumping fluids into the open abdomen. What is DPR? Why do it? Who should get it? Does it work? Come try and stay awake for some basic science talk before then learning all about why you should consider adopting DPR into your Trauma/EGS practice? Join Drs. Cobler-Lichter, Kwon, Meizoso, Urréchaga, and Rattan as they guide you through all this and more!
Hosts:
Michael Cobler-Lichter, MD, PGY2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (twitter)
Eva Urrechaga, MD, PGY6/R4:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@urrechisme (twitter)
Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 3 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@jpmeizoso (twitter)
Rishi Rattan, MD, Attending Surgeon in Trauma/Critical Care, 7 years in practice
Legacy Emanuel Medical Center
@DrRishiRattan (twitter)
Learning Objectives:
- State the proposed benefits of DPR
- Identify who can benefit from DPR
- Demonstrate the proper way to set up a DPR circuit
- Discuss the proposed basic science mechanism for DPR’s efficacy
Quick Hits:
1. Consider DPR in all your open abdomens in EGS/Trauma. You never know when you’re going to be able to close some of these patients.
2. The principal of DPR is to allow the fluid to dwell in the abdomen as long as possible. Keep the catheter deep and don’t put holes in your dressing.
3. DPR is ideal for patients with packing, who are in discontinuity, and for fresh anastomoses. These will only benefit from DPR, not be harmed by it.
4. Make sure these patients are receiving hourly I/Os. Nursing by-in is huge for this procedure.
5. DPR is associated with higher rates of fascial closure, reduces inflammation, and improves blood flow to the abdomen.
References
Hosts:
Michael Cobler-Lichter, MD, PGY2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (twitter)
Eva Urrechaga, MD, PGY6/R4:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@urrechisme (twitter)
Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 3 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@jpmeizoso (twitter)
Rishi Rattan, MD, Attending Surgeon in Trauma/Critical Care, 7 years in practice
Legacy Emanuel Medical Center
@DrRishiRattan (twitter)
Learning Objectives:
- State the proposed benefits of DPR
- Identify who can benefit from DPR
- Demonstrate the proper way to set up a DPR circuit
- Discuss the proposed basic science mechanism for DPR’s efficacy
Quick Hits:
1. Consider DPR in all your open abdomens in EGS/Trauma. You never know when you’re going to be able to close some of these patients.
2. The principal of DPR is to allow the fluid to dwell in the abdomen as long as possible. Keep the catheter deep and don’t put holes in your dressing.
3. DPR is ideal for patients with packing, who are in discontinuity, and for fresh anastomoses. These will only benefit from DPR, not be harmed by it.
4. Make sure these patients are receiving hourly I/Os. Nursing by-in is huge for this procedure.
5. DPR is associated with higher rates of fascial closure, reduces inflammation, and improves blood flow to the abdomen.
References
- Ribeiro-Junior MAF, Cássia Tiemi Kawase Costa, de Souza Augusto S, et al. The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review. Eur J Trauma Emerg Surg. Published online November 13, 2021. doi:10.1007/s00068-021-01821-x
- Smith JW, Garrison RN, Matheson PJ, Franklin GA, Harbrecht BG, Richardson JD. Direct Peritoneal Resuscitation Accelerates Primary Abdominal Wall Closure after Damage Control Surgery. J Am Coll Surg. 2010;210(5):658-667. doi:10.1016/j.jamcollsurg.2010.01.014
- Smith JW, Neal Garrison R, Matheson PJ, et al. Adjunctive treatment of abdominal catastrophes and sepsis with direct peritoneal resuscitation: indications for use in acute care surgery. J Trauma Acute Care Surg. 2014;77(3):393-398; discussion 398-399. doi:10.1097/TA.0000000000000393
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