Intra-abdominal hypertension complicating pancreatitis-induced acute respiratory distress syndrome in three patients on extracorporeal membrane oxygenation

Abstract

Background: Severe acute pancreatitis is associated with sever multiorgan failure from 15 to 50%, depending on the series. In some of these patients, conventional methods of ventilation and respiratory support will fail, demanding the use of extracorporeal membrane oxygenation (ECMO). Abdominal compartment syndrome is potentially harmful in this cohort of patients. We describe the successful treatment of three patients with severe acute pancreatitis who underwent respiratory ECMO and where intra abdominal pressure was monitored regularly. Methods: Retrospective review of case notes. Results: Three patients with severe acute pancreatitis requiring ECMO suffered from increased intra abdominal pressure during their ICU stay. No surgical interventions were taken to relieve abdominal compartment syndrome. Survival to hospital discharge was 100% Conclusions: Monitoring intraabdominal pressure is a valuable adjunct to decision making while caring for these high-risk critically ill patients.

Application and outcomes of extracorporeal life support in emergency general surgery and trauma

“…The patients in our study were on ECMO support for a mean of 7.5 days, this compares to 9.3 days in the study by Guirand et al, although shorter average ECLS durations of 5 days have been reported. [12][13][14]17,32,35 Our study's total hospital length of stay also appears to be shorter, at 23.5 days, this compares to 25-40 days in previous studies. [12][13][14]17,32,35 Our hypothesized contributor to this survival is the emphasis on euvolemia, or net zero cumulative fluid balance (CFB) during daily multidisciplinary rounds.…”

“…14,17,[19][20][21] Adult Respiratory Distress Syndrome can also complicate the course of many acute care surgery pathologies, the most studied among them being acute pancreatitis, where it affects up to 30% of patients. 13 In patients with severe ARDS, there is a high mortality risk with conventional treatment. [12][13] Extracorporeal membrane oxygenation has been described in the trauma and surgical populations with promising results.…”

“…13 In patients with severe ARDS, there is a high mortality risk with conventional treatment. [12][13] Extracorporeal membrane oxygenation has been described in the trauma and surgical populations with promising results. A retrospective study by Guirand et al described 26 patients with severe ARDS by the Berlin criteria secondary to trauma who were placed on VV ECMO and compared their outcomes to a matched cohort of candidates managed at a different institution without ECMO capabilities.…”

“…These studies cite survival rates between 63% and 100%. 12,13 While often initiated in-hospital, ECMO's portability allows for experienced centers to bring the staff and equipment off-site, to another facility, and implant/initiate ECMO at a patient's bedside, thereby stabilizing a patient in place and allowing for interfacility transport of an otherwise hemodynamically unstable patient (ECMO-on-the-Go). We describe the short-term outcomes in the application of ECMO and ECMO-onthe-Go in the acute care surgery population at our tertiary care center with the largest ECMO-on-the-Go experience in Connecticut.…”

Diaphragmatic dysfunction in sepsis due to severe acute pancreatitis complicated by intra-abdominal hypertension

“…3 SAP complicated by IAH is prone to sepsis and respiratory failure. 3,4 SAP is one of the most common reasons for respiratory failure, whereas IAH precipitates exudation of pulmonary alveoli. SAP results in a longer length of hospitalization and higher mortality of sepsis.…”