Early abdominal re-exploration for 'failure to thrive' in the ICU

Aviel Roy-Shapira, Weksler Nathan, Gabriel M. Gurman

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: When patients who are admitted to the ICU following abdominal operations fail to improve, the reason is often obscure, and the identification of surgically correctable lesions can be delayed, with dire consequences. We therefore adopted a policy of early re-exploration for patients who "fail to thrive"(FTT) in the ICU. Setting: a general closed 12 bed critical care unit of a 1200 bed teaching hospital Methods: FTT was defined as any of the following: progressive SIRS, failure of 1 or more organ system, persistent fever, persistent positive fluid balance, leukocytosis or leukopenia, and failure to wean from mechanical ventilation. When the ICU attending identified FTT, without an obvious cause. the surgeon was approached and relaparotomy suggested. The re-operation was scheduled at the discretion of the surgeon. Some were operated within 48h (early group), some after more than 72h,(delayed group) and some were not explored (non-op group). All FTT patients were followed until dischage from the hospital or death. Abdominal sepsis was usually treated with the open abdomen approach, χ2 and Fisher exact test were used for statistical analysis (Epiinfo 6.04b, CDC, atlanta) Results: 41 patients met the criteria for FTT. Mean age was 59 (29-77), Median APACHE II score on the day FTT was identified was 21 (15-31). Original laparotomy was due to trauma in 25%, other emergency operation in 29%, and elective in 44%. Overall mortality was 54%. 7 patients were not explored, of which one survived. Of the 9 in the delayed group 2 survived. In the early group, 16/25 survived. (p=0.02). The re-laprotomy was negative in 29% of the 34 patients who were re-explored, and hopeless in 18%. When the laprotomy was negative mortality was 44%. 38% of the patients with negative CT had a surgically correctable lesion. There were 2 complications directly attibutable to re-exploration, but none in patients with negative findings. Conclusions: In sick patients with a recent abdominal operation who fail to improve without an obvious cause, relaparotomy appears to be the most effective means of achieving a diagnosis. Negative exploration does not add to the morbidity. Negative imaging is not reliable.

Original languageEnglish
Pages (from-to)A117
JournalCritical Care Medicine
Volume27
Issue number12 SUPPL.
DOIs
StatePublished - 1 Jan 1999
Externally publishedYes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint

Dive into the research topics of 'Early abdominal re-exploration for 'failure to thrive' in the ICU'. Together they form a unique fingerprint.

Cite this