Critical Care Management of Peritonitis in a Low-Resource Setting

Jennifer Rickard, Christian Ngarambe, Leonard Ndayizeye, Blair Smart, Robert Riviello, Jean Paul Majyambere

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Management of critically ill patients is challenging in a low-resource setting. In Rwanda, peritonitis is a common surgical condition where patients often present late, with advanced disease. We aim to describe critical care management of patients with peritonitis in Rwanda. Methods: Data were collected at a tertiary referral hospital in Rwanda on patients undergoing operation for peritonitis over a 6-month period. Data included epidemiology, hospital course and outcomes. Patients requiring admission to the intensive care unit (ICU) were compared with those not requiring ICU admission using Chi-square and Wilcoxon rank-sum test. Results: Over a 6-month period, 280 patients were operated for peritonitis. Of these, 46 (16.4%) were admitted to the ICU. The most common diagnoses were intestinal obstruction (N = 17, 37.0%) and typhoid intestinal perforation (N = 6, 13.0%). Thirty-nine (89%) patients had sepsis. The median American Society of Anesthesiologist score was 3 (range 2–4), and the median Surgical Apgar Score was 4 (range 0–6). Twenty-four (52.2%) patients required vasopressors, with dopamine and adrenaline being the only vasopressors available. Patients admitted to the ICU, compared with non-critically ill patients, were more likely to have major complications (80.4 vs. 14%, p < 0.001), unplanned reoperation (28 vs. 10%, p < 0.001) and death (72 vs. 8%, p < 0.001). Conclusion: Patients with peritonitis admitted to the ICU commonly presented with features of sepsis. Due to limited resources in this setting, interventions are primarily supportive with intravenous fluids, intravenous antibiotics, ventilator support and vasopressors. Morbidity and mortality remain high in this patient population.

Original languageEnglish (US)
Pages (from-to)3075-3080
Number of pages6
JournalWorld Journal of Surgery
Volume42
Issue number10
DOIs
StatePublished - Oct 1 2018

Bibliographical note

Funding Information:
Funding Funding for Rwanda Human Resources for Health Program was provided by the Centers for Disease Control and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Publisher Copyright:
© 2018, Société Internationale de Chirurgie.

Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.

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