Modified, bicarbonate-augmented direct peritoneal resuscitation for refractory acidosis after damage control laparotomy: a single-center case series.

INTRODUCTION: Despite the utilization of damage control laparotomy (DCL) in acute care surgery, refractory acidosis remains a formidable challenge. This retrospective case series describes our experience with modified direct peritoneal resuscitation (DPR) with sodium bicarbonate in conjunction with DCL as an adjunct for refractory acidosis. METHODS: We present a retrospective case series of nine adult patients from one tertiary care center following DCL with refractory acidosis treated with DPR using 1.5% peritoneal dialysate with 300 mEq of sodium bicarbonate per 2 L bag. RESULTS: The change in patients' pre-intervention vs 24-hour post-intervention pH was significant, 0.25 (95% CI 0.011 to 0.392; p=0.031). The change in lactic acid at 24 hours was also significant at -10.2 (mmol/L) (95% CI -16.9 to -3.6; p=0.016). Changes in norepinephrine doses trended down, but did not reach statistical significance. CONCLUSION: Further investigation of DPR with sodium bicarbonate for managing refractory acidosis in patients who undergo DCL is warranted.