Direct Peritoneal Resuscitation: A review

• Direct Peritoneal Resuscitation (DPR) instills hypertonic solution into the abdomen in addition to IV resuscitation.
• DPR causes rapid vasodilation and improves visceral organ blood flow after shock.
• DPR reduces edema and allows earlier abdominal closure after damage control surgery.
• DPR reduces serum levels of inflammatory cytokines and other mediators.
• DPR increases the number of organs procured per donor after acute brain death.

Conventional treatment for hemorrhagic shock includes the infusion of intravenous (IV) fluid and blood products in order to restore intravascular volume. However, even after normal heart rate and blood pressure are restored, the visceral organs often remain ischemic. This leads to organ dysfunction and also releases numerous cytokines and inflammatory mediators which activate the body's inflammatory response. The use of Direct Peritoneal Resuscitation (DPR) helps counteract this response. DPR involves infusion of hypertonic fluid into the abdomen in addition to IV resuscitation. This causes rapid and sustained dilation of the arterioles, especially those in the intestine, which reduces organ ischemia and cellular hypoxia. Studies in animals have demonstrated that use of DPR after hemorrhagic shock can reduce organ edema, improve liver blood flow, and reduce serum levels of inflammatory cytokines. Subsequent human studies have shown that DPR after damage control surgery for hemorrhage or sepsis leads to faster abdominal closure, higher rate of primary fascial closure, and reduced abdominal complications. Peritoneal resuscitation has also shown benefits in the resuscitation after acute brain death, including reduced inflammatory mediators and organ edema. Use of DPR in potential organ donors leads to an increase in the number of organs procured per donor, most frequently by increasing the number of lungs procured.