{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:35:55Z","timestamp":1787150155106,"version":"build-2736575974"},"reference-count":14,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"unspecified","delay-in-days":49,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2026,8,2]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Despite the utilization of damage control laparotomy (DCL) in acute care surgery, refractory acidosis remains a formidable challenge. This retrospective case series describes our experience with modified direct peritoneal resuscitation (DPR) with sodium bicarbonate in conjunction with DCL as an adjunct for refractory acidosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present a retrospective case series of nine adult patients from one tertiary care center following DCL with refractory acidosis treated with DPR using 1.5% peritoneal dialysate with 300 mEq of sodium bicarbonate per 2 L bag.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The change in patients\u2019 pre-intervention vs 24-hour post-intervention pH was significant, 0.25 (95% CI 0.011 to 0.392; p=0.031). The change in lactic acid at 24 hours was also significant at \u221210.2 (mmol\/L) (95% CI \u221216.9 to \u22123.6; p=0.016). Changes in norepinephrine doses trended down, but did not reach statistical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Further investigation of DPR with sodium bicarbonate for managing refractory acidosis in patients who undergo DCL is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2026-002430","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:20:23Z","timestamp":1787149223000},"page":"e002430","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Modified, bicarbonate-augmented direct peritoneal resuscitation for refractory acidosis after damage control laparotomy: a single-center case series"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4206-9762","authenticated-orcid":false,"given":"Grayson","family":"Mast","sequence":"first","affiliation":[{"name":"Surgery, EVMS, Norfolk, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Carver","sequence":"additional","affiliation":[{"name":"Surgery, Guam Regional Medical City, Tamuning, Guam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M","family":"Rice","sequence":"additional","affiliation":[{"name":"Surgery, EVMS, Norfolk, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Burgess","sequence":"additional","affiliation":[{"name":"Surgery, EVMS, Norfolk, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026081907201401000_11.3.e002430.1","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1097\/00005373-200011000-00033","article-title":"Damage Control: Collective Review","volume":"49","author":"Shapiro","year":"2000","journal-title":"The Journal of Trauma: Injury, Infection, and Critical Care"},{"key":"2026081907201401000_11.3.e002430.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.12.065"},{"key":"2026081907201401000_11.3.e002430.3","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.jamcollsurg.2016.12.047","article-title":"Randomized Controlled Trial Evaluating the Efficacy of Peritoneal Resuscitation in the Management of Trauma Patients Undergoing Damage Control Surgery","volume":"224","author":"Smith","year":"2017","journal-title":"J Am Coll 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