Respiratory Complications in Acute Pancreatitis

Ranson, John H. C.; Turner, James; Roses, Daniel F.; Rifkind, Kenneth; Spencer, Frank C.

doi:10.1097/00000658-197405000-00006

Cited by 119 publications

(65 citation statements)

References 31 publications

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“…7,27,28 Several hypotheses have been explored and several associated inflammatory mediators and signalling pathways have been identified regarding the underlying pathophysiology, 8,29,30 however the exact mechanisms remain incompletely understood. The spectrum of sequelae of AP-associated respiratory dysfunction ranges from subclinical hypoxaemia to severe ARDS, 31,32 and radiologically evident complications such as atelectasis, pleural effusion, and pulmonary infiltrates and/or oedema may frequently be present, amongst others. 33,34 Nevertheless, hypoxaemia may precede radiological findings and has been described as an early indicator of pathological pulmonary changes.…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasonography as a direct measure of evolving respiratory dysfunction and disease severity in patients with acute pancreatitis

Skouras

Davis

Sharkey

et al. 2015

HPB

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Section: Discussionmentioning

confidence: 99%

Lung ultrasonography as a direct measure of evolving respiratory dysfunction and disease severity in patients with acute pancreatitis

Skouras

Davis

Sharkey

et al. 2015

HPB

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“…Pulmonary changes compatible with acute lung injury and acute respiratory distress syndrome [4] are frequent in patients with severe AP [1,2,3, 5]. The pancreatitis-associated lung injury is a complex and incompletely understood process.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure due to Severe Acute Pancreatitis

et al. 2006

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Background:Patients with acute pancreatitis (AP) who require mechanical ventilation have high morbidity and mortality rates. Noninvasive positive pressure ventilation (NPPV) delivered through a mask has become increasingly popular for the treatment of acute respiratory failure (ARF) and may limit some mechanical ventilation complications. Objectives: The purpose of this retrospective, observational study was to evaluate our clinical experience with the use of NPPV in AP patients with ARF. Methods: From 1997 to 2003, we documented clinical data, gas exchange and outcome of the 62 AP patients admitted to our intensive care unit. Patients who benefited from NPPV (success) were compared with those who failed (intubated). Results:Twenty-nine patients were intubated at admission and 5 did not develop ARF. Of the 28 patients treated with NPPV, 15 were not intubated (54%). Both groups had a similar PaO₂/FiO₂ ratio (142 ± 21 vs. 133 ± 20; p = 0.127) and severity of illness (Ranson and Balthazar scores). Presence of atelectasis, bilateral alveolar infiltrates and abdominal distension were associated with failure of NPPV. Oxygenation improved and respiratory rate decreased significantly only in the success group. Additionally, the length of stay at the intensive care unit was significantly lower in the success group. Conclusion: NPPV is feasible and safe to treat ARF in selected patients with AP who require ventilatory support.

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“…1,2 Patients with severe AP develop pulmonary dysfunction, which clinically resembles the acute respiratory distress syndrome of sepsis. 3 Despite advances in the diagnosis and treatment of inflammatory pancreatic disease, supportive care remains the only treatment for patients with pulmonary complications.…”

Section: Discussionmentioning

confidence: 99%

Blocking Pulmonary ICAM-1 Expression Ameliorates Lung Injury in Established Diet-Induced Pancreatitis

Lundberg¹,

Fukatsu²,

Gaber³

et al. 2001

Annals of Surgery

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ObjectiveTo determine whether blocking the cell surface expression of intracellular adhesion molecules (ICAM-1) in established severe acute pancreatitis (AP) would ameliorate pulmonary injury. Summary Background DataLung injury in AP is in part mediated by infiltrating leukocytes, which are directed to lung tissue by ICAM-l. The authors' laboratory has previously demonstrated that AP results in overproduction of inflammatory cytokines, upregulation of pulmonary ICAM-1 expression, and a concomitant infiltration of neutrophils, which results in lung injury. MethodsYoung female mice were fed a choline-deficient/ethioninesupplemented diet to induce AP and were treated with a blocking dose of monoclonal antibody specific to the ICAM-1 receptor. Antibody treatment was administered at 72, 96, and 120 hours after beginning the diet, and all animals were killed at 144 hours. The degree of pancreatitis was evaluated by serum biochemical and tumor necrosis factor ␣ levels as well as histology. The dual radiolabeled monoclonal antibody method was used to quantitate ICAM-1 cell surface expression in pulmonary tissue. Lung injury was assessed histologically and by determining lung microvascular permeability by measuring accumulated 125 I-radiolabeled albumin. Pulmonary neutrophil sequestration was determined by the myeloperoxidase assay. ResultsAll mice developed severe AP, and pancreatic injury was equally severe in both treated and untreated groups. Pulmonary ICAM-1 expression was significantly upregulated in animals with AP compared with controls. Treatment with a blocking dose of anti-ICAM-1 antibody after the induction of AP resulted in inhibited ICAM-1 cell surface expression to near control levels. Compared to untreated animals with AP, mice treated with anti-ICAM-1 mice had significantly reduced histologic lung injury and neutrophil sequestration, and a decreased microvascular permeability by more than twofold. ConclusionsThese results demonstrate for the first time that treatment targeting the cell surface expression of ICAM-1 after the induction of AP ameliorates pulmonary injury, even in the face of severe pancreatic disease.

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Respiratory Complications in Acute Pancreatitis

Cited by 119 publications

References 31 publications

Lung ultrasonography as a direct measure of evolving respiratory dysfunction and disease severity in patients with acute pancreatitis

Lung ultrasonography as a direct measure of evolving respiratory dysfunction and disease severity in patients with acute pancreatitis

Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure due to Severe Acute Pancreatitis

Blocking Pulmonary ICAM-1 Expression Ameliorates Lung Injury in Established Diet-Induced Pancreatitis

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