Outcome of patients with severe abdominal sepsis in intensive care - experience at Charlotte Maxeke Johannesburg Academic Hospital

摘要

Despite advances in diagnosis, surgery, antimicrobial therapy and intensive care support, the mortality rate associated with intra-abdominalsepsis remains unacceptably high. The aim of the present study was to identify prognostic factors in 54 consecutive cases with abdominalsepsis admitted to the intensive care unit (ICU) over a two-year period, from January 2001 to December 2002. This was a retrospective recordreview of cases with abdominal sepsis admitted to the ICU. Of 54 patients that were studied, only 14 survived. The mortality rate was 74.1%.Non-survivors had significantly longer ICU stay, had more relook laparotomies, more blood transfusions and a significantly higher APACHEII score on admission to the ICU. Other results revealed that non-survivors required significantly more inotropic support and corticosteroids,had a lower paO 2 /FiO 2 ratio and had more total parenteral nutrition days. None of the patients who survived required dialysis. The number ofrelook laparotomies were higher in the non-survivors and the maximum number of relook laparotomies were four in the survivors and 13 inthe non-survivors. The non-survivors were also more likely to have an open abdomen. We conclude that patients with abdominal sepsis havean extremely high mortality and utilise an enormous amount of limited intensive care resources. The length of ICU stay, APACHE II score onadmission, number of relook laparotomies, whether the abdomen was left open or not, and requirement for inotropic support, dialysis, totalparenteral nutrition and blood transfusions were predictive of adverse outcomes in these patients.