Abstract

Objective

To investigate the functional status of systemic and pulmonary hemodynamics in patients with peritonitis of varying severity in order to provide an objective assessment of their condition and support a personalized approach to treatment.
 

Materials and Methods

This prospective study included 100 patients with peritonitis and 30 apparently healthy individuals in the control group. Patients were divided into three groups: those without signs of systemic inflammatory response syndrome (n=40), those with signs of systemic inflammatory response (n=35), and those with sepsis or septic shock (n=25). Disease severity and the degree of organ dysfunction were assessed using the APACHE II and SOFA scores. Echocardiographic and Doppler examinations were performed to assess heart rate, stroke volume, cardiac output, cardiac index, total peripheral vascular resistance, and pulmonary hemodynamic parameters.
 

Results

As peritonitis severity increased, a shift in hemodynamic profiles was observed, from predominantly eukinetic and hyperkinetic patterns in patients without systemic inflammatory response to a hypokinetic pattern in patients with sepsis and septic shock. A progressive decrease in stroke volume and cardiac index was recorded in the most severely affected subgroups, accompanied by an increase in systolic and mean pulmonary artery pressure and a decrease in the AT/ET ratio. The severity of pulmonary circulatory disturbances increased in parallel with disease severity.
 

Conclusion

Changes in systemic and pulmonary hemodynamics in patients with peritonitis are dynamic and associated with the severity of systemic inflammatory response and organ dysfunction. Comprehensive assessment of central hemodynamics and pulmonary artery pressure may serve as an additional tool for severity stratification and personalization of hemodynamic support.
 

Keywords

peritonitis abdominal sepsis septic shock central hemodynamics pulmonary hemodynamics cardiac index pulmonary hypertension echocardiography.

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