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Research Snapshot Theater: Sepsis/Shock, Adult II

Preliminary Use of Direct Peritoneal Resuscitation With Bicarbonate for Correction of Acidosis

Monday, March 23, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 16

  • Grayson Mast, MD (he/him/his)

    Virginia

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • RC

    Ryan Carver, MD

    Assistant Professor
    Macon & Joan Brock Virginia Health Sciences at Old Dominion University

    Disclosure information not submitted.

  • JB

    Jessica Burgess, BS, MD

    Associate Professor
    Eastern Virginia Medical School

    Disclosure information not submitted.

Introduction: Damage control laparotomy (DCL) is a crucial intervention in Acute Care Surgery aimed at stabilizing patients in critical condition. Despite advances in surgical techniques and critical care, refractory acidosis remains a formidable challenge. 'Failure to rescue' scenarios where unresolved metabolic derangements prevail are common. This study explores the utility of direct peritoneal resuscitation (DPR) with sodium bicarbonate as an adjunct for correcting severe acidosis in patients with open abdomens post-DCL. We hypothesize that its use is associated with decreased lactic acid levels and vasopressor requirements, improved capacity for Continuous Renal Replacement Therapy (CRRT), and pH.


Methods: A retrospective review of nine adult patients from one tertiary care center who underwent DCL from 2020 to 2023 was carried out. These patients experienced refractory metabolic acidosis following DCL and were treated with 1.5% peritoneal dialysate with 300 mEq of sodium bicarbonate per bag. We analyzed changes in pH and lactic acid levels, vasopressor requirements, and mortality. Patients with incomplete data were excluded from the final statistical analysis.


Results: The average patient in this cohort was 54 years ± 22. The mortality rate was 66%. The percentage of patients on CRRT increased from 22% to 77% after the intervention. The change in patients' pre-intervention versus 24-hour post-intervention pH was significant, 0.25 (95% CI: 0.011 to 0.392); p=0.003. The change in lactic acid at 24 hours was also significant at -10.2 (mmol/L) (95% CI: -16.9 to -3.6); p=0.005. Changes in norepinephrine doses (mcg/min) trended down but did not reach statistical significance at 24-hour and 72-hour intervals, -15 (95% CI: -34 to 3); p=0.047 and -21 (95% CI: -43 to 2); p=0.034, respectively.


Conclusions: Direct peritoneal resuscitation with sodium bicarbonate is a promising intervention for managing refractory acidosis in patients with open abdomens post-damage control laparotomy; particularly, those with renal failure that cannot tolerate CRRT due to hemodynamic instability. Future research, such as a multi-center, blinded, randomized clinical controlled trial should be pursued to formally assess this salvage therapy for those with refractory acidosis and an open abdomen.