• Marcelo Augusto Fontenelle Ribeiro-Junior, Cássia Tiemi Kawase Costa, Samara de Souza Augusto, Paola Rezende Néder, Yasmin Garcia Batista Elia, Rishi Rattan, Peritoneal Resuscitation Study Group, and Salomone Di Saverio.
• Division of Trauma and General Surgery, Hospital Municipal Dr. Jose de Carvalho Florence, Faculdade de Ciências Médicas de São José dos Campos, Humanitas, Catholic University of São Paulo, Rua Joubert Wey, 290, Vila Boa Vista, Sorocaba, SP, Brazil. drmribeiro@gmail.com.
• Eur J Trauma Emerg Surg. 2022 Apr 1; 48 (2): 791-797.

PurposeDirect peritoneal resuscitation (DPR) has been used to help preserve microcirculation by reversing vasoconstriction and hypoperfusion associated with the pathophysiological process of shock, which can occur despite appropriate intravenous resuscitation. This approach depends on infusing a hyperosmolar solution intraperitoneally via a percutaneous catheter with the tip ending near the pelvis or the root of the mesentery. The abdomen is usually left open with a negative pressure abdominal dressing to continuously evacuate the infused dialysate. Hypertonicity of the solution triggers visceral vasodilation to help maintain blood flow, even during shock, and is also associated with reduced local inflammatory cytokines and other mediators, preservation of endothelial cell function, and mitigation of organ edema and necrosis. It also has a direct effect on liver perfusion and edema, more rapidly corrects electrolyte abnormalities compared to intravenous resuscitation alone, and may requireless intravenous fluid to stabilize blood pressure, all of which shortens the time required to close patients' abdomen.MethodsAn online query using the search term "direct peritoneal resuscitation" was carried out in PubMed, MEDLINE and SciELO, limited to publications indexed from January 2014 to June 2020. Of the 20 articles returned, full text was able to be obtained for 19. A manual review of included articles' references was resulted in the addition of 1 article, for a total of 20 included articles.ResultsThe 20 articles were comprised of 15 animal studies, 4 clinical studies,and 1 expert opinion. The benefits include both local and possibly systemic effects on perfusion, hypoxia, acidosis, and inflammation, and are associated with improved outcomes and reduced complications.ConclusionDPR shows promise in patients with hemorrhagic shock, septic shock, and other conditions resulting in an open abdomen after damage control laparotomy.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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