<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0034-7493</journal-id>
<journal-title><![CDATA[Revista Cubana de Cirugía]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cubana Cir]]></abbrev-journal-title>
<issn>0034-7493</issn>
<publisher>
<publisher-name><![CDATA[Editorial Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0034-74932021000400010</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Peritonitis terciaria como reto para los cuidados intensivos]]></article-title>
<article-title xml:lang="en"><![CDATA[Tertiary Peritonitis as a Challenge for Intensive Care]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Calas Rodríguez]]></surname>
<given-names><![CDATA[Alfredo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pérez Assef]]></surname>
<given-names><![CDATA[Héctor]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Araujo Pradere]]></surname>
<given-names><![CDATA[Leopoldo José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Ciencias Médicas de La Habana Hospital Universitario Clínico-Quirúrgico &#8220;Hermanos Ameijeiras&#8221; Unidad de Cuidados Intensivos]]></institution>
<addr-line><![CDATA[ La Habana]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>60</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S0034-74932021000400010&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S0034-74932021000400010&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S0034-74932021000400010&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  Las infecciones intrabdominales son consideradas como una de las primeras causas de emergencias quirúrgicas a nivel mundial. El reconocimiento de la peritonitis terciaria como una nueva forma de sepsis de origen intrabdominal y disfunción- falla multiorgánica es creciente, pero no unánime.  Objetivo:  Realizar un análisis de la literatura sobre la peritonitis terciaria, su definición, elementos fisiopatológicos, factores de riesgo y terapéutica.  Método:  Se realizó una búsqueda en las bases de datos Pubmed, LILACS, SciELO y Google académico. Se utilizaron palabras clave, términos DeCs y MESH, en el periodo de búsqueda 2010-2020 en idioma inglés y español, con el fin de proporcionar los conceptos, clasificaciones y manejo integral en el abordaje de la peritonitis terciaria. Los tipos de estudios seleccionados fueron guías, revisiones sistemáticas, ensayos clínicos aleatorizados y estudios observacionales.  Desarrollo:  Se definió como una inflamación peritoneal que persistió o recurrió después de 48 horas, con signos clínicos de irritación peritoneal, tras un tratamiento aparentemente adecuado que siguió a una peritonitis secundaria y producida por patógenos nosocomiales. Es una entidad que tuvo una elevada mortalidad, que cuenta con elementos necesarios para su diagnóstico, con una flora bacteriana característica, generalmente microorganismos de baja virulencia unido a predisposición por paciente inmunocomprometido y los elementos claves para su tratamiento son la antibiótico terapia y un manejo quirúrgico adecuado.  Conclusiones: A pesar de la gravedad extrema de esta entidad, existen ambigüedades en su definición, diagnóstico y tratamiento. Los estudios sobre el tema abordan definiciones muy heterogéneas y por tanto los resultados son muy variables.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Intraabdominal infections are considered one of the leading causes of surgical emergencies worldwide. Recognition of tertiary peritonitis as a new form of sepsis of intraabdominal origin and multi-organ dysfunction and/or failure is increasing, but not unanimous.  Objective:  To carry out an analysis of the literature about tertiary peritonitis, its definition, pathophysiological elements, risk factors, and therapy.  Method:  A search was carried out in the databases of Pubmed, LILACS, SciELO and Google Scholar. Keywords, as well as DeCs and MESH terms were used in the search period 2010-2020, in English and Spanish, in order to provide the concepts, classifications and the comprehensive management for tertiary peritonitis. The types of studies selected were guidelines, systematic reviews, randomized clinical trials, and observational studies.  Development:  The condition was defined as a peritoneal inflammation that persisted or recurred after 48 hours, with clinical signs of peritoneal irritation, after apparently adequate treatment that followed secondary peritonitis caused by nosocomial pathogens. The entity had a high mortality, with necessary elements for its diagnosis: a characteristic bacterial flora, generally low virulence microorganisms and predisposition to affect immunocompromised patients. The key elements for its treatment are antibiotic therapy and suitable surgical management.  Conclusions:  Despite the extreme severity of this entity, there are ambiguities in its definition, diagnosis and managment. Studies on the subject address very heterogeneous definitions and, therefore, the outcomes are highly variable.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[infecciones intrabdominales]]></kwd>
<kwd lng="es"><![CDATA[peritonitis terciaria]]></kwd>
<kwd lng="es"><![CDATA[sepsis]]></kwd>
<kwd lng="en"><![CDATA[intraabdominal infections]]></kwd>
<kwd lng="en"><![CDATA[tertiary peritonitis]]></kwd>
<kwd lng="en"><![CDATA[sepsis]]></kwd>
</kwd-group>
</article-meta>
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