“TO STUDY THE MORTALITY PREDICTION OF ICU PATIENTS WITH PERFORATION PERITONITIS, REQUIRING EMERGENCY LAPAROTOMY’’

Main Article Content

Dr. Ravi Pratap Singh
Dr. Anil Dawar
Dr. Vikram Singh Mujalde
Dr. Pramod Pandey

Keywords

SICU, emergency laparotomy, perforation peritonitis.

Abstract

Introduction- Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It’s the primary cause of death from infection, especially if not recognized and treated promptly. It’s a syndrome caused by pathogen factors and host factors with characteristics that evolve over time. What differentiates sepsis from infection is an aberrant or dysregulated host response and the presence of organ dysfunction. The clinical and biological phenotype of sepsis can however be modified by preexisting acute illness, long-standing co-morbidities, medication, and interventions.


 Aims and objectives- ‘’to study the mortality prediction of ICU patients with perforation eritonitis, requiring emergency laparotomy’’


Methods and materials- This is a prospective cohort study done in a tertiary care center in central India ‘’


 conducted in the department of General Surgery Department of Surgery in people’s college of  medical science and research Centre, Bhopal for two-year study in 50 patients. Surgical Abdominal Sepsis admitted in surgical intensive care unit (SICU) during study period, for two years.


Inclusion criteria– All the patients ≥16 years of age admitted in SICU, as a result of perforation peritonitis requiring exploratory laparotomy and willing to participate in the study after written informed consent were included.  Age<16years and patient with Sepsis secondary to trauma, Laparotomies for non-septic indications are excluded from study.


After obtaining Ethical clearance from Institute’s Ethical Committee, all the patients fulfilling the inclusion criteria were enrolled in the study. Written consent was obtained from all the study participants. The participants were divided in two groups i.e. survivors and non survivors based on their outcome.


 Results- -Mean age of patients in present study was 36±16.14 years. In the present study 42(84%) out of 50 patients were males while 8(16%) were females. All 5 patients who died were males. Most common etiology of SABS was small intestine perforation (36%) followed by gastric perforation (26%). Mean Apache score was maximum in intra-abdominal abscess (105) followed by ischemia (57) and gastric perforation and was minimum in large intestine perforation (29.3). Mean of MAP of 45 patients in survivor group was 82.55 mmHg while the same in non-survivors was 75 mm Hg. Mechanical ventilation was used in total of 3 patients, out of which 1 survived and 2patients succumbed to death. The association of mechanical ventilation usage with mortality (chi square test) amongst survivors and non survivors was found to be statistically significant (p=0.0008).


Deranged Sodium was seen in 11 out of 45 survivors (24.4%) and 2 out of 5(40%) non-survivors. The survivors had a mean urine output of 1020 ml and non-survivors had a mean urine output of 350 ml. In case of serum creatinine; mean of survivor group was 0.98 while in non-survivors is1.74. Mean albumin in survivor group was 3.09mg/dl and in non-survivors was1.94. In present study, 12 patients had APS score less than 30 with no mortality. 1 out of 31 patients in 30-60 score range died while 4 out of 7 died in case of score >60. A receiver operating characteristic (ROC) curve, comparative analysis of the mortality predictions with APACHE IV is done and shows AUC =0.911 and p <0.001. Thus, shows the high predictive efficacy of APACHE IV score. The mean observed length of stay of all patients was 6.65 days against an expected LOS (length of stay) of 4.6 days. Overall O:E Ratio was 1.44 against O:E of 1.21 in non-survivors with observed and expected LOS of 10.2 and 8.42 days. The difference was statistically significant with p value =0.02.


Conclusion- From this study we concluded that, results in terms of Length of stay are not accurate and a further work upon the same is required. Results of the study may be improved if sample size was bigger.


Hence, a larger study with greater sample size and if possible, involvement of multiple centers is recommended which could help in reaching some conclusive and milestone results.


From this study we evaluate the mortality of ICU patients with perforation peritonitis requiring emergency laparotomy, which is essential for all healthcare workers

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