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Excerpt
Materials and Methods: 11 patients having elective left sided colorectal resection with primary anastomosis in a university teaching hospital were recruited to have IPMD monitoring for up to 48 hours post-operatively. Concurrent physiological and biochemical parameters were recorded.
Results and Discussions: Median (range) age was 60 (29-76) years and median (range) length of hospital stay was 11 (6-32) days. IPMD sample collection demonstrated a mean (95% CI) intraperitoneal lactate/pyruvate ratio of 24 (17-30), normal range being 19 ± 4. Two patients developed early post-operative anastamotic complications, displaying elevations in lactate/pyruvate ratio of 240% and 177% over baseline, these episodes associated with concurrent periods of systemic hypotension. A rise of greater than 60% in lactate/ pyruvate ratio has been shown to be suggestive of mesenteric ischaemia (1). No other patients demonstrated elevations of lactate/pyruvate ratio to this extent. Primary pathology, volume of fluid administration, use of vasopressor therapy and use of epidural analgesia was not shown to significantly affect IPMD results.
Conclusion(s): Post-operative intra-peritoneal microdialysis analysis performed in the critical care unit highlighted that in two patients, one with clinical suggestion of mesenteric ischaemia and one with a confirmed anastamotic leak, an early elevation of lactate/pyruvate ratio in the post-operative period was recorded. Further evaluation of IPMD as an adjunct to guiding administration of fluid or vasoactive therapies in the critical care unit following colorectal resection is warranted.
