Recovery from respiratory failure after decompression laparotomy for severe acute pancreatitis

Siebig, Sylvia; Iesalnieks, Igors; Bruennler, T.; Dierkes, Christine; Langgartner, Julia; Schöelmerich, Juergen; Wrede, Christian

doi:10.3748/wjg.14.5467

Cited by 12 publications

(4 citation statements)

References 16 publications

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“…Fortunately, animal and human studies have shown that abdominal decompressive laparotomy can reverse the pulmonary and abdominal detrimental effects of IAH Siebig et al, 2008). In the present study, with the relief of IAH after decompressive laparotomy, total lung volume and PaO 2 /FIO 2 improved while the diaphragmatic displacement and the non-aerated lung volume decreased (Although it improved, the PaO 2 /FIO 2 after decompressive laparotomy remained below the normal ranges).…”

Section: Discussionmentioning

confidence: 55%

Effect of increased intra-abdominal pressure and decompressive laparotomy on aerated lung volume distribution

Zhou

Pan

et al. 2010

J. Zhejiang Univ. Sci. B

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Increased intra-abdominal pressure (IAP) is common in intensive care patients, affecting aerated lung volume distribution. The current study deals with the effect of increased IAP and decompressive laparotomy on aerated lung volume distribution. The serial whole-lung computed tomography scans of 16 patients with increased IAP were retrospectively analyzed between July 2006 and July 2008 and compared to controls. The IAP increased from (12.1±2.3) mmHg on admission to (25.2±3.6) mmHg (P<0.01) before decompressive laparotomy and decreased to (14.7±2.8) mmHg after decompressive laparotomy. Mean time from admission to decompressive laparotomy and length of intensive-care unit (ICU) stay were 26 h and 16.2 d, respectively. The percentage of normally aerated lung volume on admission was significantly lower than that of controls (P<0.01). Prior to decompressive laparotomy, the total lung volume and percentage of normally aerated lung were significantly less in patients compared to controls (P<0.01), and the absolute volume of non-aerated lung and percentage of non-aerated lung were significantly higher in patients (P<0.01). Peak inspiratory pressure, partial pressure of carbon dioxide in arterial blood, and central venous pressure were higher in patients, while the ratio of partial pressure of arterial O 2 to the fraction of inspired O 2 (PaO 2 /FIO 2 ) was decreased relative to controls prior to laparotomy. An approximately 1.8 cm greater cranial displacement of the diaphragm in patients versus controls was observed before laparotomy. The sagittal diameter of the lung at the T6 level was significantly increased compared to controls on admission (P<0.01). After laparotomy, the volume and percentage of non-aerated lung decreased significantly while the percentage of normally aerated lung volume increased significantly (P<0.01). In conclusion, increased IAP decreases total lung volume while increasing non-aerated lung volume. Decompressive laparotomy is associated with resolution of these effects on lung volumes.

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Section: Discussionmentioning

confidence: 55%

Effect of increased intra-abdominal pressure and decompressive laparotomy on aerated lung volume distribution

Zhou

Pan

et al. 2010

J. Zhejiang Univ. Sci. B

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“…Knowledge about surgical decompression for ACS in patients with SAP is limited and is mainly based on published case series with high mortality. 8,19,20 …”

Section: Discussionmentioning

confidence: 99%

Surgical Decompression for Abdominal Compartment Syndrome in Severe Acute Pancreatitis

Mentula¹

2010

Arch Surg

133

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Patients with severe acute pancreatitis and abdominal compartment syndrome managed by surgical decompression had severe multiple-organ dysfunction syndrome and high mortality. Surgical decompression may improve renal or respiratory function. Early surgical decompression is associated with reduced mortality in patients with severe acute pancreatitis, early multiple-organ dysfunction syndrome, and abdominal compartment syndrome.

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“…In contrast, more and more studies are published promoting the decompression laparotomy for SAP patients developing ACS defi ned by IAP greater than 20 mmHg associated with new organ failure. This procedure can not only prevent a critical decrease of intestinal and renal perfusion, but may lead to an improvement of the respiratory situation (2,14).…”

Section: Management Of Iah In Patients With Sapmentioning

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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Recovery from respiratory failure after decompression laparotomy for severe acute pancreatitis

Cited by 12 publications

References 16 publications

Effect of increased intra-abdominal pressure and decompressive laparotomy on aerated lung volume distribution

Effect of increased intra-abdominal pressure and decompressive laparotomy on aerated lung volume distribution

Surgical Decompression for Abdominal Compartment Syndrome in Severe Acute Pancreatitis

Intra-abdominal hypertension and acute pancreatitis

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