The peritoneal cavity as a reservoir for systemic inflammation
IAH, ischemia, inflammation, infection, intra-abdominal infections
NECROTIZING PANCREATITIS, INTRA-ABDOMINAL INFECTION, ISCHEMIA, INFLAMMATION, DISEASE, INFECTION, CAVITY, SECONDARY PERITONITIS
There is a complex relationship between pressure, ischemia, and inflammation within the peritoneal cavity [The biologic rationale for COOL is that if safe, removing intraperitoneal bio-mediators may mitigate their local effects and prevent their being absorbed systemically. Although early work suggested a benefit of simple continuous peritoneal lavage after either gross peritoneal contamination in secondary peritonitis or in the setting of necrotizing pancreatitis [NPPT therapy may be a more direct, earlier, and focused solution to this complicated problem, and one that will be complementary to the other benefits of OA. Whether improved postoperative courses can be obtained through this relatively simpler approach of actively removing peritoneal cytokines with a more efficient and comprehensive VAC therapy in humans is therefore part of the biologic rationale of the COOL trial.Another potential benefit of NPPT after severe infection may be the attendant decompression of the abdominal compartment and prevention of even modest IAH. Patients with intra-abdominal infections are at risk of elevated IAP both because of the primary intraperitoneal disease, and as a consequence of the use of large-volume crystalloid resuscitation often used to maintain organ perfusion [