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  • Meeting abstract
  • Open Access

The relationship between adult respiratory distress syndrome (ARDS) stage and severity of intra-abdominal sepsis (or intoxication parameters) in early postoperative period

  • 1 and
  • 1
Critical Care19971 (Suppl 1) :P028

https://doi.org/10.1186/cc34

  • Published:

Keywords

  • Peritonitis
  • Prognostic Index
  • Adult Respiratory Distress Syndrome
  • Clinical Information System
  • Lethal Outcome

Objectives

To find the relationship between severity of intra-abdominal sepsis, intoxication level and intensity of respiratory failure in peritonitis patients.

Design

Prospective clinical-diagnostic study of peritonitis patients on the lst-14th day after surgery.

Subjects

We examined 82 patients (300 observations) from 14 to 81 years-old with different abdominal aetiology.

Methods

To monitor the lung respiratory function we evaluated respiration, peak of CO2 pressure at the end of inhalation, ventilation/perfusion relation, O2 and CO2 pressure in arterial capillary blood. The clinical information system for permanent monitoring of circulation was used to register the heart rate, stroke and cardiac indexes, system arterial resistance index, systolic and diastolic arterial pressure, central venous pressure and also impedance between breast and neck electrodes during central reography. We determined middle molecules (MM) and serum urine nitrogen (SUN) levels by spectrophotometry. To estimate patient's severity score the integral prognostic index (PI) was calculated using parameters mentioned above, laboratory and some clinical data (Surgery 1993, 10:16–19). PI value fluctuated between 0 and 1, where 0–0.1 predicted lethal outcome and 0.9–1, survival, 0.1–0.9 range was subdivided into some intermediate statuses. We made a conclusion about ARDS stage employing decisive rules of diagnostic algorithm that were found using values of external ventilation parameters, blood gas pressure and central reography data (Intensive Care Med 1996, 22:410). Correlation analysis was used for statistical data processing.

Results

According to the data obtained we found that the aetiology of peritonitis and type of intra-abdominal exudate had no sufficient influence on ARDS developing. ARDS stage and the extension of peritonitis were weakly (r = -0.17) but reliably (P < 0.02) correlated: ARDS developed frequently in patients with generalized peritonitis. ARDS stages III and IV were never found in diffused peritonitis. Severe ARDS stages were observed in later period after surgery. The possibility of lethal outcome (MOR) progressively increased as respiratory failure was deepening. The investigation of relationship between PI and ARDS stage showed weak but sufficient correlation. Some intoxication parameters were also correlated with ARDS stage (see table).

Conclusion

Statistically reliable relationships between ARDS stage and some parameters reflecting peritonitis severity and its outcome confirm that this syndrome influences significantly the status of these patients. However, values of correlation coefficients indicate that ARDS is important but not sole syndrome injury which makes its contribution to peritonitis pathogenesis. On the other hand, ARDS developing (which is a component of intra-abdominal sepsis pathogenesis) is caused not only by stress effect of initial lung microcirculation alteration but also by adequacy of organism reaction, ie compensatory possibility of the given homeostatic system.

Table

 

MOR

PI

MM

SUN

ARDS stage

r = 0.34

r = -0.43

r = 0.29

r = 0.50

 

P < 0.0001

P < 0.0001

P < 0.0001

P < 0.0001

Authors’ Affiliations

(1)
Medical Department, Russian State Medical, ul Medikov 14 Ap 325, Moscow, 115304, Russia

Copyright

© Current Science Ltd 1997

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