Direct peritoneal resuscitation in sepsis and intra-abdominal infection: A scoping review

BACKGROUND Direct peritoneal resuscitation (DPR) has been primarily studied in trauma and hemorrhagic shock, where it improves visceral perfusion and facilitates abdominal closure. Its application in sepsis and intra-abdominal infection (IAI) has emerged more recently, supported by limited experimental and clinical data. Persistent visceral hypoperfusion, intestinal barrier dysfunction, and inflammatory dysregulation in sepsis provide a biological rationale for peritoneal-based resuscitation strategies. However, the scope, characteristics, and consistency of the available evidence in septic settings remain unclear. We hypothesized that existing studies would be sparse, heterogeneous, and largely non-comparative. AIM To map and characterize existing evidence on DPR in sepsis and IAI. METHODS A scoping review was conducted following Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and LILACS were searched, supplemented by grey literature and citation tracking. Clinical, neonatal, and experimental studies evaluating DPR or related peritoneal-based resuscitation strategies in sepsis or IAI were eligible. Data were charted descriptively. No quantitative synthesis was performed. RESULTS From 1064 records, five studies met inclusion criteria: two adult clinical cohorts, two neonatal studies, and one experimental animal study. Adult and neonatal studies reported associations between DPR and improvements in selected physiological or metabolic parameters, including acid-base status, urine output, and illness severity scores. Adult cohorts also reported higher primary fascial closure rates following damage control surgery. Experimental data suggested protective effects on intestinal physiology and inflammatory markers. Study designs, populations, interventions, and outcomes were heterogeneous, and most evidence was observational or preclinical, with limited comparative data. CONCLUSION Current evidence suggests biological plausibility and feasibility of DPR in selected septic contexts, but data are limited, heterogeneous, and non-comparative, warranting prospective clinical investigation.