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Intensive Care Medicine

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01-08-2016 | My Paper 20 Years Later

Therapeutic management of peritonitis: a comprehensive guide for intensivists

Authors: P. Montravers, S. Blot, G. Dimopoulos, C. Eckmann, P. Eggimann, X. Guirao, J. A. Paiva, G. Sganga, J. De Waele

Published in: Intensive Care Medicine | Issue 8/2016

Abstract

Purpose

The management of peritonitis in critically ill patients is becoming increasingly complex due to their changing characteristics and the growing prevalence of multidrug-resistant (MDR) bacteria.

Methods

A multidisciplinary panel summarizes the latest advances in the therapeutic management of these critically ill patients.

Results

Appendicitis, cholecystitis and bowel perforation represent the majority of all community-acquired infections, while most cases of healthcare-associated infections occur following suture leaks and/or bowel perforation. The micro-organisms involved include a spectrum of Gram-positive and Gram-negative bacteria, as well as anaerobes and fungi. Healthcare-associated infections are associated with an increased likelihood of MDR pathogens. The key elements for success are early and optimal source control and adequate surgery and appropriate antibiotic therapy. Drainage, debridement, abdominal cleansing, irrigation, and control of the source of contamination are the major steps to ensure source control. In life-threatening situations, a "damage control" approach is the safest way to gain time and achieve stability. The initial empirical antiinfective therapy should be prescribed rapidly and must target all of the micro-organisms likely to be involved, including MDR bacteria and fungi, on the basis of the suspected risk factors. Dosage adjustment needs to be based on pharmacokinetic parameters. Supportive care includes pain management, optimization of ventilation, haemodynamic and fluid monitoring, improvement of renal function, nutrition and anticoagulation.

Conclusions

The majority of patients with peritonitis develop complications, including worsening of pre-existing organ dysfunction, surgical complications and healthcare-associated infections. The probability of postoperative complications must be taken into account in the decision-making process prior to surgery.

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Title: Therapeutic management of peritonitis: a comprehensive guide for intensivists
Authors: P. Montravers
S. Blot
G. Dimopoulos
C. Eckmann
P. Eggimann
X. Guirao
J. A. Paiva
G. Sganga
J. De Waele
Publication date: 01-08-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 8/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4307-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Therapeutic management of peritonitis: a comprehensive guide for intensivists

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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