The use of bedside diagnostic laparoscopy in the intensive care unit.

BACKGROUND: The clinical evaluation of the abdomen in intensive care (ICU) patients who are intubated can be very complex. Many bedside diagnostic tests are available to assist the clinician, including ultrasound, peritoneal lavage, and plain X-rays. However, in the ICU setting, these tests can be unreliable. An abdominal computed tomography (CT) scan is more reliable, but it requires transportation to the Radiology Department, which can be risky. In this paper, we present our experience with bedside laparoscopy in the general ICU population.

METHODS: Between April 2004 and November 2007, 35 adult patients (19 male, 16 female), with a mean age of 69 years (range, 39-83), underwent bedside diagnostic laparoscopy (DL) in the ICU. Hemodynamic and ventilatory parameters as well as the time required for the DL and CT scan procedure were compared. In addition, the ASA, APACHE II, and SOFA scores were documented.

RESULTS: Laparoscopic findings were negative for intra-abdominal disease in 57.1% (n = 20) patients. The remaining patients (42.9%; n = 15) had positive laparoscopic findings for intra-abdominal disease. The overall mortality rate in our group of patients was 60%. The time required for DL was less (21.8 +/- 7.6 minutes) than the time required for a CT scan (38.2 +/- 6.2 minutes; P < 0.05). Three patients went on to have a therapeutic procedure in the ICU.

CONCLUSION: The evaluation of the critically ill patient for intra-abdominal pathology with DL is a practical solution and needs to be used more frequently in this setting. In this paper, we present our experience with diagnostic laparoscopy in the ICU and found it to be safe and, in certain cases, may have a potential role as a bedside therapeutic tool. Although a number of reports with small series of patients have addressed the benefits and feasibility of DL, it is still being underutilized in the ICU. A more aggressive attempt should be made to incorporate DL as a routine procedure in the ICU.