Journal Review in Trauma Surgery: Direct Peritoneal Resuscitation

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 30 October 2023

⏱️ 33 minutes

🔗️ Recording | iTunes | RSS

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Summary

Direct Peritoneal Resuscitation! We’re not just dumping fluids into the open abdomen. What is DPR? Why do it? Who should get it? Does it work? Come try and stay awake for some basic science talk before then learning all about why you should consider adopting DPR into your Trauma/EGS practice? Join Drs. Cobler-Lichter, Kwon, Meizoso, Urréchaga, and Rattan as they guide you through all this and more!

Hosts:
Michael Cobler-Lichter, MD, PGY2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (twitter)

Eva Urrechaga, MD, PGY6/R4:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@urrechisme (twitter)

Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center

Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 3 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@jpmeizoso (twitter)

Rishi Rattan, MD, Attending Surgeon in Trauma/Critical Care, 7 years in practice
Legacy Emanuel Medical Center
@DrRishiRattan (twitter)

Learning Objectives:
- State the proposed benefits of DPR
- Identify who can benefit from DPR
- Demonstrate the proper way to set up a DPR circuit
- Discuss the proposed basic science mechanism for DPR’s efficacy

Quick Hits:
1. Consider DPR in all your open abdomens in EGS/Trauma. You never know when you’re going to be able to close some of these patients.
2. The principal of DPR is to allow the fluid to dwell in the abdomen as long as possible. Keep the catheter deep and don’t put holes in your dressing.
3. DPR is ideal for patients with packing, who are in discontinuity, and for fresh anastomoses. These will only benefit from DPR, not be harmed by it.
4. Make sure these patients are receiving hourly I/Os. Nursing by-in is huge for this procedure.
5. DPR is associated with higher rates of fascial closure, reduces inflammation, and improves blood flow to the abdomen.

References

Ribeiro-Junior MAF, Cássia Tiemi Kawase Costa, de Souza Augusto S, et al. The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review. Eur J Trauma Emerg Surg. Published online November 13, 2021. doi:10.1007/s00068-021-01821-x
Smith JW, Garrison RN, Matheson PJ, Franklin GA, Harbrecht BG, Richardson JD. Direct Peritoneal Resuscitation Accelerates Primary Abdominal Wall Closure after Damage Control Surgery. J Am Coll Surg. 2010;210(5):658-667. doi:10.1016/j.jamcollsurg.2010.01.014
Smith JW, Neal Garrison R, Matheson PJ, et al. Adjunctive treatment of abdominal catastrophes and sepsis with direct peritoneal resuscitation: indications for use in acute care surgery. J Trauma Acute Care Surg. 2014;77(3):393-398; discussion 398-399. doi:10.1097/TA.0000000000000393

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Transcript

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0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.
0:22.5	We're the Miami trauma team, back with another episode from Jackson Memorial Hospitals and
0:27.0	Riders Trauma Center. This episode, in which we will focus on a recent systematic review on
0:32.3	direct phirginal resuscitation or DPR, we have the privilege of being joined by guest host Dr. Rishi
0:38.3	Ratan, a member of the first iteration of the Miami Trauma team. As always, we'd like to start with
0:43.6	some introductions. I'm Mike Cobbler-Lichter, PGY3 in general surgery in my first or two years of
0:49.1	dedicated research with our trauma faculty here in Miami. My name is Eva Retiga, I'm a PGY7 in
0:54.3	general surgery also in Miami. I'm Yvniac Juan, trauma and surgical critical care fellow at the
0:59.6	Riders Trauma Center. And I'm Jonathan May So-so, I'm an attending trauma surgeon at the
1:04.3	Riders Trauma Center and assistant professor of surgery at the University of Miami. I'm Rishi Ratan,
1:09.4	I'm attending trauma surgeon at Legacy and Manual Hospital in Portland, Oregon. And as Mike
1:13.4	mentioned, I'm what you can consider behind the night Miami Trauma team alumnus. As Eva and I, we're
1:17.9	part of the original Miami trauma team, back when I was an attending at Riders, and I'm happy to be
1:22.8	back. Thanks for having me. Happy to have you back, Dr. Ratan. So today, we will be discussing
1:27.3	a topic that's still pretty cutting edge direct pair to meal resuscitation. So what is it?
1:31.7	Why do we deal with it? Who should get it? We're going to talk about all these things and more
1:35.2	using a recent systematic review published by Drs. Ribeiro, who brought DPR to Brazil and Savedio,
1:41.8	who is a nurse international guidelines with the World Society of Emergency Surgery,
1:45.9	including on open abdomen to guide our discussion. All paper references will be linked in the show
1:51.2	notes, and we're very thankful to have Dr. Ratan with us today, who is actually a co-author on this
1:55.5	paper, and is somewhat of a DPR expert. So let's get into it with a little bit of background.
2:01.5	What exactly is DPR? I had honestly never heard of it before starting residency here in Miami.
	...

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