Intra-Abdominal Pressure Reduction After Percutaneous Catheter Drainage Is a Protective Factor for Severe Pancreatitis Patients With Sterile Fluid Collections

Liu, Liye; Luo, Haiwei; Dai, Ruiwu; Liang, Hongyin; Chen, Tao; Hao, Yan; Cui, Jianfeng; Li, Nanlin; Yang, Wei; Liu, Weihui; Tang, Lijun

doi:10.1097/mpa.0000000000000420

Cited by 29 publications

(12 citation statements)

References 40 publications

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“…Removal of pancreatic necrosis and/or infected tissue leads to the interruption of the inflammatory cascade and a decrease in IAP resulting in the decrease of serum inflammatory markers. 35 The fact that IL-6 levels fell at day 3 post-PCD and CRP levels at day 7 post-PCD in our study suggests that a halt in macrophage stimulation by IL-6 is followed by a decrease in CRP production. While we estimated levels of CRP, IL-6, and IL-10 only on days 3 and 7 of PCD, other workers have estimated levels of CRP periodically until the removal of the PCD catheter.…”

Section: Discussionsupporting

confidence: 42%

“…In our patients, this happened in all the patients subjected to PCD, with a greater decrease in the patients who improved after PCD. Removal of pancreatic necrosis and/or infected tissue leads to the interruption of the inflammatory cascade and a decrease in IAP resulting in the decrease of serum inflammatory markers . The fact that IL‐6 levels fell at day 3 post‐PCD and CRP levels at day 7 post‐PCD in our study suggests that a halt in macrophage stimulation by IL‐6 is followed by a decrease in CRP production.…”

Section: Discussionmentioning

confidence: 52%

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Change in serum levels of inflammatory markers reflects response of percutaneous catheter drainage in symptomatic fluid collections in patients with acute pancreatitis

et al. 2019

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Background Percutaneous catheter drainage (PCD) is used as the first step in the management of symptomatic fluid collections in patients with acute pancreatitis (AP). There are limited data on the effect of PCD on inflammatory markers. Aim To study the effects of PCD on serum levels of C‐reactive protein (CRP), IL‐6, and IL‐10 and its correlation with the outcome. Methods Consecutive patients of AP with symptomatic fluid collections undergoing PCD were evaluated for serum levels of CRP, IL‐6, and IL‐10 before PCD and at 3 and 7 days after PCD. Resolution of organ failure (OF), sepsis, and pressure symptoms was considered to demonstrate the success of PCD. Changes in levels following PCD were correlated with outcome. Results Indications of PCD in 59 patients (age 38.9 ± 13.17 years, 49 male) were suspected/documented infected pancreatic necrosis ( n = 45), persistent OF ( n = 40), and pressure symptoms ( n = 7). A total of 49 (83.1%) patients improved with PCD, five patients required surgery, and six died. A significant difference was noted between baseline levels of CRP ( P = 0.026) and IL‐6 ( P = 0.013) among patients who improved compared to those who worsened following PCD. Significant decrease ( P < 0.01) of all three markers on day 3 of PCD insertion, with further decrease ( P < 0.01) on day 7, was noted. The percentage of the decrease of IL‐6 levels on day 3 and of CRP on day 7 correlated with the outcome. Conclusion PCD is associated with a significant decrease in CRP, IL‐6, and IL‐10 levels. Percentage decrease in IL‐6 on day 3 and CRP on day 7 correlated with the outcome of patients managed with PCD.

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Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 52%

Change in serum levels of inflammatory markers reflects response of percutaneous catheter drainage in symptomatic fluid collections in patients with acute pancreatitis

et al. 2019

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“…На сьогоднішній день, рандомізовані клінічні дослідження і публікації демонструють суперечливі дані щодо ефективності хірургічних втручань при гострому панкреатиті ускладненому асцит-перитонітом [1,2,3,4]. Разом з тим, евакуація ферментативно-активного ексудату з черевної порожнини підтримується в ряді публікацій [5,6,7], як раціональний захід для полегшення стану хворих з гострим тяжким панкреатитом, в тому числі за рахунок зменшення больової імпульсації.…”

Section: вступunclassified

Assessment of the Efficiency of Treatment Ascites-Peritonitis in Patients With Severe Acute Pancreatitis

Кас’ян

2019

Act. Probl. of the Modern Med.

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The incidence of acute pancreatitis in Ukraine is 102 per 100,000 of the population, the total mortality rate ranges from 4% to 15%, and with necrotic form it is 24-60%, postoperative mortality reaches 70%. To date, randomized clinical trials and publications show conflicting data on the effectiveness of surgical interventions in acute pancreatitis complicated by ascites-peritonitis. The aim of the work was to analyze the effect of drainage interventions on the intensity of the pain syndrome and the dynamics of restoration of enteral nutrition in acute pancreatitis complicated by ascites-peritonitis. The study analyzed the results of a comprehensive examination and treatment of 166 patients with acute necrotic pancreatitis with enzymatic ascites-peritonitis. In patients with an initial severity of the condition rated on the APACHE II scale as 5 or more points, a positive effect of draining interventions at the start of treatment of acute pancreatitis was observed compared with non-drained patients of similar severity at the time of hospitalization, which was manifested by the disappearance of pain and restoration of self-enteral nutrition after 72 hours in most patients of these subgroups. Therefore, the elimination of enzymatic ascites can reliably reduce the intensity of the pain syndrome and contribute to the restoration of independent enteral nutrition and can be recommended for consideration as an element of the complex treatment of acute pancreatitis complicated by ascites-peritonitis in patients with the initial severity of the condition rated on the APACHE II scale as 5 or more points. Further studies are needed to study other possible positive effects of drainage interventions and determine clear indications for their conduct in the early period of the disease.

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“…Less morbid therapies have been described to manage or prevent IAH without the need to proceed to a full decompressive laparotomy [36][37][38][39]. It is now possible that we may wish to have an open abdomen in the sickest septic patient not because we have to, but because we want to.…”

Section: The Futurementioning

confidence: 99%

Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017

Kirkpatrick¹,

Sugrue²,

McKee³

et al. 2017

Anaesthesiol Intensive Ther

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Intra-Abdominal Pressure Reduction After Percutaneous Catheter Drainage Is a Protective Factor for Severe Pancreatitis Patients With Sterile Fluid Collections

Abstract: Intra-abdominal PCD for acute sterile fluid collections seems to be an effective option rather than peripancreatic PCD. Patients with a significant decrease of IAP had a lower incidence of infection and better alleviation of organ failure.

Cited by 29 publications

References 40 publications

Change in serum levels of inflammatory markers reflects response of percutaneous catheter drainage in symptomatic fluid collections in patients with acute pancreatitis

Change in serum levels of inflammatory markers reflects response of percutaneous catheter drainage in symptomatic fluid collections in patients with acute pancreatitis

Assessment of the Efficiency of Treatment Ascites-Peritonitis in Patients With Severe Acute Pancreatitis

Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017

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