Intra-abdominal pressure as a marker of severity in acute pancreatitis

Rosas, José Manuel Hidalgo; Soto, Salvador Navarro; Serra‐Aracil, Xavier; Cladera, Pere Rebasa; Borlán, Raquel Hernández; Sánchez, A. Vázquez; Ros, F. Bory; Posa, Luis Grande

doi:10.1016/j.surg.2006.04.016

Cited by 59 publications

(35 citation statements)

References 13 publications

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“…In another study, the maximum IAP was 19 mmHg in patients who developed an infected pancreatic necrosis, whereas it was 11 mmHg in patients with an uncomplicated course. Therefore, it is likely that IAH is involved to some extent in both development of necrosis and infection of the necrosis, the two major determinants of outcome (20).…”

Section: Pathophysiology Of Acsmentioning

confidence: 99%

Intra-abdominal hypertension and acute pancreatitis

Mifkovič¹,

Skultety²,

Sýkora³

et al. 2013

BLL

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Intra-abdominal hypertension (IAH) contributes to organ dysfunction and leads to the development of the abdominal compartment syndrome (ACS). IAH and ACS are relatively frequent fi ndings in patiens with severe acute pancreatitis (SAP) and are associated with deterioration in organ functions. The most affected are cardiovascular, respiratory and renal functions. The incidence of IAH in patients with SAP is approximately 60-80%. There is an accumulating evidence in human and animal studies that changes of perfusion, particularly to the microvasculature, are crucial events in the progression of acute pancreatitis (AP). The perfusion of the small and large intestine is impaired due to reduced arterial pressure, increased vascular resistence and diminished portal blood fl ow. Bacterial translocation has been described in patients with ACS, and this may apply to patients with SAP. Approximately 30-40% of SAP patients develop ACS because of pancreatic (retroperitoneal) infl ammation, peripancreatic tissue edema, formation of fl uid collections or abdominal distension. Surgical debridement was the preferred treatment to control necrotizing pancreatitis in the past. However, the management of necrotizing pancreatitis has changed over the last decade. The main objective of this article is to describe the association between IAH and AP and to emphasize this situation in clinical praxis as well (Fig. 1

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Section: Pathophysiology Of Acsmentioning

confidence: 99%

Intra-abdominal hypertension and acute pancreatitis

Mifkovič¹,

Skultety²,

Sýkora³

et al. 2013

BLL

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“…These variables could affect the mortality rate, because it is exactly these scoring systems used to assess the probability of death. In other studies, it has been proven that patients with acute pancreatitis had higher values of IAP, APACHE II score, SOFA score, lactate, and BMI (10,15,(19)(20)(21).…”

Section: Discussionmentioning

confidence: 86%

“…According to the latest guidelines (2,6,7,10,14,16,18,19) for acute pancreatitis it is noted that in recent years admission to hospitals for acute pancreatitis has increased from 40 to 70 per 100,000. Mortality due to acute pancreatitis still remains high.…”

Section: Discussionmentioning

confidence: 99%

The influence of intraabdominal pressure on the mortalityrate of patients with acute pancreatitis

Svorcan¹,

Stojanović²,

Stevanović³

et al. 2017

Turk J Med Sci

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Background/aim: Intraabdominal hypertension (IAH) is a common clinical finding in patients with acute pancreatitis and is associated with poor prognosis. This study aimed to determine the impact of intraabdominal pressure (IAP) on the mortality rate in patients with acute pancreatitis in an intensive care unit.Materials and methods: A total of 50 patients with acute pancreatitis were included in this prospective cohort study. Based on the obtained values of IAP, the patients were divided into two groups: those with normal IAP (n = 14) and increased IAP (n = 36). Mean values of IAP were compared with examined variables. Results:The mortality rate of the study group was 40%. Comparing the IAP and treatment outcomes, it was proved that there were statistically highly significant differences (P = 0.012). Increasing the value of IAP increased the mortality rate. Deceased patients in the IAH group had greater statistical significance of APACHE II score (P = 0.016), abdominal perfusion pressure (P = 0.048), lactate (P = 0.049), hematocrit (P = 0.039), Ranson's criteria on admission (P = 0.017), Ranson's criteria after 48 h (P = 0.010), Sequential Organ Failure Assessment score (P = 0.014), and body mass index (P = 0.012) compared to the surviving patients. Conclusion:IAP has an impact on the increase of mortality rates in patients with acute pancreatitis.

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“…Over the past decade, most studies depicted ACS as a terminal prognostic event, with a reported incidence of IAH and ACS in severe disease of 59% to 84% and 25% to 56% respectively [15][16][17][18][19][20][21]. Wide variability within the literature has resulted from small study population sizes, heterogeneous diagnostic criteria, as well as inconsistent methodology for IAP measurement.…”

Section: Acute Pancreatitismentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

Bressan

Ball

2017

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension, even preceding the onset of abdominal compartment syndrome, is still recognized as an adverse prognostic factor. Unfortunately, most of the current supporting evidence within the critical care environment remains observational in nature. In acute pancreatitis, an active role for intra-abdominal hypertension early in the disease process follows a strong intuitive basis, and it is corroborated by preliminary evidence from animal models. Additional studies are needed to better characterize the optimal fluid resuscitation strategy, as well as the importance of intra-abdominal hypertension as an early therapeutic target. All critically ill patients with acute pancreatitis should be considered for routine intra-abdominal pressure monitoring. The prevalence and clinical relevance of intra-abdominal hypertension after elective major abdominal operations are underestimated in the literature. Hepato-pancreato-biliary surgery and liver transplantation represent high-risk surgical subspecialties, and routine intra-abdominal hypertension risk assessment to indicate postoperative intra-abdominal pressure monitoring can be recommended. Conservative management of intra-abdominal hypertension should be promptly initiated upon diagnosis. Although abdominal catheter drainage and decompressive laparotomy may be required in refractory cases based on expert clinical judgment, precise indications and timing are still unclear. Implementation of institutional protocols based on the Abdominal Compartment Society reference standards is crucial to optimize both clinical management and research in this evolving area.

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Intra-abdominal pressure as a marker of severity in acute pancreatitis

Cited by 59 publications

References 13 publications

Intra-abdominal hypertension and acute pancreatitis

Intra-abdominal hypertension and acute pancreatitis

The influence of intraabdominal pressure on the mortalityrate of patients with acute pancreatitis

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

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