Intensive care unit management of intra-abdominal infection

OBJECTIVE: To review the biologic characteristics of, and management approaches to, intra-abdominal infection in the critically ill patient. DESIGN: Narrative review. SETTING: Medline review focussed on intra-abdominal infection in the critically ill patient. PATIENTS AND SUBJECTS: Restricted to studies involving human subjects. INTERVENTIONS: None. RESULTS: Intra-abdominal infections are an important cause of morbidity and mortality in the intensive care unit (ICU). Peritonitis can be classified as primary, secondary, or tertiary, the unique pathologic features reflecting the complex nature of the endogenous gut flora and the gut-associated immune system, and the alterations of these that occur in critical illness. Outcome is dependent on timely and accurate diagnosis, vigorous resuscitation and antibiotic support, and decisive implementation of optimal source control measures, specifically the drainage of abscesses and collections of infected fluid, the debridement of necrotic infected tissue, and the use of definitive measures to prevent further contamination and to restore anatomy and function. CONCLUSIONS: Optimal management of intra-abdominal infection in the critically ill patient is based on the synthesis of evidence, an understanding of biologic principles, and clinical experience. An algorithm outlining a clinical approach to the ICU patient with complex intra-abdominal infection is presented.