Consideration of postoperative blood purification therapy to improve tissue oxygenation and contribute to good prognosis in patients experiencing gastrointestinal perforation associated with septic shock

Abstract

We carried out management on patients experiencing gastrointestinal (GI) perforation associated with septic shock using a protocol that included resuscitation by early goal-directed therapy (EGDT) and early source control. 137 patients were divided into an EGDT completed group and an EGDT not-completed group. The EGDT completed group are patients who achieved ScvO₂ of 70% within one hour after surgery of source control. In the results, a 60 day survival rate of 98% was observed in the EGDT completed group, but only 30% in the EGDT not-completed group (p-value＜0.001). The blood purification therapy was performed in all 37 cases in the EGDT not-completed group. In four cases in the EGDT not-completed group, ScvO₂ continuous monitoring and blood purification therapy was performed after surgery. Two cases showed improvement in ScvO₂ during blood purification therapy, and survived. However, two cases continued to have a low ScvO₂ and did not survive. ScvO₂ after surgery of source control may demonstrate a prognostic predictive value, and blood purification therapy may improve tissue oxygenation and contribute to good prognosis.