caa a22 4500 475779533 CHVBK 20180406123640.0 cr unu---uuuuu 170329e20000701xx s 000 0 eng 10.1007/s004640010068 doi (NATIONALLICENCE)springer-10.1007/s004640010068 The feasibility and accuracy of diagnostic laparoscopy in the septic ICU patient [Elektronische Daten] [J. J. Kelly, J. C. Puyana, M. P. Callery, S. M. Yood, A. Sandor, D. E. M. Litwin] Background: Systemic inflammatory response syndrome (SIRS) and sepsis of unknown origin are common complications of critically ill patients in the ICU. These patients frequently have unreliable clinical exams and are candidates for exploratory laparotomy. Although abdominal CT is commonly used because it is less invasive than laparotomy, it is often unreliable or unobtainable. Bedside laparoscopy is an alternative technique that may be more accurate than CT in selected patients and less invasive than laparotomy. Methods: We performed diagnostic laparoscopy (DL) in a series of ICU patients with SIRS/septic state of unknown origin between May 1997 and June 1998. All patients were unstable and required significant respiratory and hemodynamic support. Laparoscopy was either performed in the ICU at the patient's bedside or in the operating room. CT scan of the abdomen had been performed on most of the patients who were stable enough to transport. Confirmation of diagnosis was obtained either by laparotomy, autopsy, or clinical recovery. Results: Among the 17 eligible patients, 16 underwent successful DL. Insufflation was impossible in one patient because of high intraabdominal pressure. Bedside evaluations were performed in 14 of the 17 patients. There were no complications from the laparoscopy. Six patients were identified as positive (four intestinal ischemia, two cholecystitis); the other 10 had negative explorations. Follow-up on two patients with negative laparoscopy was incomplete due to denied postmortem. Laparoscopic diagnoses were confirmed in the remaining 14 patients by laparotomy (six cases), postmortem (three cases), or recovery (five cases), with an accuracy of 100%. The overall accuracy of abdominal CT obtained in nine of the 14 patients was 33%. Conclusions: DL in a select group of critical ICU patients is safe and accurate, whereas CT scan tends to be inaccurate and is often unobtainable due to patient instability. Performing the procedure at the bedside can expedite the diagnosis, eliminate the burden for transfer, and save on anesthesia and operating room charges. Springer-Verlag New York Inc., 2000 Key words: Bedside laparoscopy — Critical care — Diagnostic laparoscopy — Mesenteric ischemia — Sepsis — Systemic inflammatory response syndrome (SIRS) nationallicence Kelly J. J. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut Puyana J. C. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA, USA aut Callery M. P. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut Yood S. M. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut Sandor A. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut Litwin D. E. M. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut Surgical Endoscopy Springer-Verlag 14/7(2000-07-01), 617-621 0930-2794 14:7<617 2000 14 464 https://doi.org/10.1007/s004640010068 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640010068 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kelly J. J. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut NATIONALLICENCE 700 1- Puyana J. C. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA, USA aut NATIONALLICENCE 700 1- Callery M. P. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut NATIONALLICENCE 700 1- Yood S. M. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut NATIONALLICENCE 700 1- Sandor A. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut NATIONALLICENCE 700 1- Litwin D. E. M. Department of Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA, USA aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/7(2000-07-01), 617-621 0930-2794 14:7<617 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer