BEDSIDE DIAGNOSTIC LAPAROSCOPY AND PERITONEAL-LAVAGE IN THE INTENSIVE-CARE UNIT

Background: Early diagnosis and treatment of intraabdominal pathology in critically ill intensive care unit (ICU) patients remains a clinica l challenge. The objective of this study is to assess the feasibility of portable, bedside diagnostic laparoscopy (DL) in the ICU for patien ts suspected of intra-abdominal pathology, and to contrast its accurac y with diagnostic peritoneal lavage (DPL). Methods: All adult ICU pati ents for whom a general surgery consultation was requested were eligib le. Patients with a recent laparotomy or obvious peritonitis were excl uded. All procedures were performed in the ICU. Results: Over a consec utive 16-month period, 12 patients underwent DPL/DL. Ages ranged from 28 to 88 (mean, 72) years. Causative findings were disclosed by DL in five patients, (42%) including intestinal ischemia in two. Perforated diverticulitis, thickened terminal ileum, and nonpurulent peritonitis were found in one patient each. All patients with findings by DL had a positive DPL (WBC > 200 cells/ mm(3)), and one negative laparoscopy w as positive by lavage. The average length of time to perform DPL was 1 4 min, and to complete DL 19 min. One patient underwent laparotomy bas ed on DPL/DL and survived along with three others with negative DPL/DL . Eight patients died (67%), four from their surgically untreated intr a-abdominal pathology. One patient sustained a procedure-related compl ication of bradycardia and high ventilatory airway pressures. Peak air way pressures increased an average of 8 mmHg and were significantly hi gher (p < 0.001) than pre-DL pressures without any significant change in end-tidal CO2 or pCO(2). There were no statistically significant he modynamic changes based on mean arterial pressure (MAP), central venou s pressure (CVP), or pulmonary artery diastolic pressure (PADP). Concl usions: Bedside laparoscopy can be performed rapidly and safely in the ICU. In predicting the need for laparotomy, DL was more accurate than DPL.