TY - JOUR
T1 - In-theater peritoneal dialysis for combat-related renal failure
AU - Pina, Joseph S.
AU - Moghadam, Soraya
AU - Cushner, Howard M.
AU - Beilman, Greg J.
AU - McAlister, Vivian C.
PY - 2010/5
Y1 - 2010/5
N2 - Background: Complications of renal failure may prevent timely evacuation of injured soldiers. Conventional renal replacement therapy is not available in forward surgical units. Methods: Records of in-theater improvised peritoneal dialysis (IPD) in level III hospitals or forward surgical units in Iraq or Afghanistan were reviewed to determine the following: cause of renal failure and associated injuries; type of dialysate, peritoneal access, and exchange technique; and patient outcome. These data were used to propose method for IPD using commonly available materials. Results: IPD is described in four patients. Abdominal or chest drains were used with either improvised dextrose-electrolyte solution or commercial dialysate. Exchanges were successful, despite fresh surgical wounds including full laparotomy, removed excess fluid and restored acid and electrolyte balance, but did not correct azotemia. Open abdominal packing prevented continuation of IPD after 48 hours. Two patients fully recovered, one died, and one patient with a poor prognosis was lost to follow-up. Conclusion: IPD can be delivered effectively using readily available materials in forward surgical units and level III combat support hospitals.
AB - Background: Complications of renal failure may prevent timely evacuation of injured soldiers. Conventional renal replacement therapy is not available in forward surgical units. Methods: Records of in-theater improvised peritoneal dialysis (IPD) in level III hospitals or forward surgical units in Iraq or Afghanistan were reviewed to determine the following: cause of renal failure and associated injuries; type of dialysate, peritoneal access, and exchange technique; and patient outcome. These data were used to propose method for IPD using commonly available materials. Results: IPD is described in four patients. Abdominal or chest drains were used with either improvised dextrose-electrolyte solution or commercial dialysate. Exchanges were successful, despite fresh surgical wounds including full laparotomy, removed excess fluid and restored acid and electrolyte balance, but did not correct azotemia. Open abdominal packing prevented continuation of IPD after 48 hours. Two patients fully recovered, one died, and one patient with a poor prognosis was lost to follow-up. Conclusion: IPD can be delivered effectively using readily available materials in forward surgical units and level III combat support hospitals.
KW - Combat-related renal failure
KW - Peritoneal dialysis
KW - Renal replacement therapy
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U2 - 10.1097/TA.0b013e3181d99089
DO - 10.1097/TA.0b013e3181d99089
M3 - Article
C2 - 20453775
AN - SCOPUS:77952276673
SN - 0022-5282
VL - 68
SP - 1253
EP - 1256
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 5
ER -