Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile?

Schmandt, Mathias; Glowka, Tim R.; Kreyer, Stefan; Muders, Thomas; Muenster, Stefan; Theuerkauf, Nils; Kalff, Jörg C.; Putensen, Christian; Schewe, Jens-Christian; Ehrentraut, Stefan

doi:10.3390/jcm10051000

Cited by 7 publications

(6 citation statements)

References 47 publications

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“… 8 33 In contrast, the survival rate in ARDS secondary to AP is only 25%, even with the use of ECMO, although none of the patients had leptospirosis. 36 In our data, we reported a higher mortality rate in the group that developed AP (31.58%) versus those who did not (12.50%). Goswami et al also reported a higher incidence of AP among patients with leptospirosis in the non-survivor group.…”

Section: Discussionsupporting

confidence: 47%

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Madrigal

Panlilio

Burog

et al. 2023

BMJ Open Gastroenterol

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BackgroundAcute pancreatitis (AP) is an infrequently reported manifestation of leptospirosis. It is more commonly seen in patients with acute respiratory distress syndrome. Despite novel modalities such as extracorporeal membrane oxygenation (ECMO), the mortality rate remains high and whether this is associated with the lung injury caused by the inflammation in AP remains unclear.Objectives and methodsA descriptive study was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of AP. Secondary outcomes were defined as 28-day mortality rate, length of hospital stay, ECMO days, renal replacement therapy (RRT) days, days on mechanical ventilation, presence of local complications of AP and development of nosocomial infections.ResultsA total of 27 patients were included in the study, and 88.89% (n=24) were men. The mean age for all patients was 33.59±10.22 years. Out of the 27 patients, 19 (70.37%) were diagnosed with AP. Among these 19 patients, one (5.26%) had necrotising pancreatitis and two (10.52%) developed local complications of pancreatitis. Six patients (31.58%) died among those who developed AP, while one (12.50%) died among those who did not. The duration of hospital stay, ECMO, RRT, mechanical ventilation and development of nosocomial infections was also higher in the group who presented with AP.ConclusionAP is an under-reported complication of leptospirosis. Our study demonstrated a higher mortality and morbidity in patients with leptospirosis who developed AP.

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Section: Discussionsupporting

confidence: 47%

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Madrigal

Panlilio

Burog

et al. 2023

BMJ Open Gastroenterol

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“…Clinicians are studying new techniques and approaches. Effect of extracorporeal membrane oxygenation [ 28 , 29 ], different levels of PEEP [ 30 ], prone positioning [ 31 , 32 ], respiratory system impedance analysis [ 33 ], and different times of weaning [ 34 ] has been studied. For the use of HFOV in the treatment of ARDS, there is a need to understand the place of HFOV in the spectrum of diagnostic and therapeutic techniques for severe ARDS care and to define the optimal HFOV strategy [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Tidal volume significantly affects oxygenation in healthy pigs during high-frequency oscillatory ventilation compared to conventional ventilation

et al. 2022

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Background The role of high-frequency oscillatory ventilation (HFOV) has long been debated. Numerous studies documented its benefits, whereas several more recent studies did not prove superiority of HFOV over protective conventional mechanical ventilation (CV). One of the accepted explanations is that CV and HFOV act differently, including gas exchange. Methods To investigate a different level of coupling or decoupling between oxygenation and carbon dioxide elimination during CV and HFOV, we conducted a prospective crossover animal study in 11 healthy pigs. In each animal, we found a normocapnic tidal volume (VT) after the lung recruitment maneuver. Then, VT was repeatedly changed over a wide range while keeping constant the levels of PEEP during CV and mean airway pressure during HFOV. Arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were recorded. The same procedure was repeated for CV and HFOV in random order. Results Changes in PaCO2 intentionally induced by adjustment of VT affected oxygenation more significantly during HFOV than during CV. Increasing VT above its normocapnic value during HFOV caused a significant improvement in oxygenation, whereas improvement in oxygenation during CV hyperventilation was limited. Any decrease in VT during HFOV caused a rapid worsening of oxygenation compared to CV. Conclusion A change in PaCO2 induced by the manipulation of tidal volume inevitably brings with it a change in oxygenation, while this effect on oxygenation is significantly greater in HFOV compared to CV.

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“…Acute respiratory distress syndrome (ARDS) is a common complication among individuals suffering from SAP, 27 potentially leading to the need for mechanical ventilation. The ability to recognize the potential for such respiratory failure and the provision of MV in a timely manner when necessary has the potential to improve patient survival.…”

Section: Discussionmentioning

confidence: 99%

Thrombo-Inflammatory Prognostic Scores Improve BISAP-Based Risk Stratification in Acute Pancreatitis Patients: A Retrospective Cohort Study

Han¹,

Cheng²,

Liao³

et al. 2022

JIR

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Purpose The thrombo-inflammatory prognostic score (TIPS) and the bedside index for severity in acute pancreatitis (BISAP) are both scoring systems that enable the rapid prognostic assessment of early-stage acute pancreatitis (AP) patients, but the overall prognostic utility of these individual systems is limited. This study was thus developed to explore whether a combination of TIPS and BISAP scores would offer better insight to facilitate the risk stratification of AP patients. Methods This single-center retrospective cohort research evaluated AP cases referred to the emergency department from January 1, 2017 to September 30, 2017. The ability of TIPS scores to improve BISAP-based AP patient risk stratification was appraised employing the curves of receiver-operating characteristic (ROC) and decision curve analysis (DCA) approaches. The initial endpoint for this research was 28-day mortality, while secondary endpoints comprised intensive care unit admission (AICU) and mechanical ventilation (MV) over a 28-day follow-up period. Results Totally, 440 cases enrolled in the current study were divided at a ratio of 1:1 to derivation and validation cohorts. When estimating 28-day mortality, the combination of TIPS and BISAP (T-BISAP) improved the area under the curve (AUC) value in the derivation group from 0.809 to 0.903 (P < 0.05), in addition to similarly improving this AUC value from 0.709 to 0.853 (P < 0.05) in the validation cohort. Moreover, T-BISAP significantly improved the AUC values for 28-day AICU from 0.751 to 0.824 (P < 0.05) and the AUC values for 28-day MV from 0.755 to 0.808 (P < 0.05). A DCA approach revealed T-BISAP to exhibit higher net benefit when used for patient risk stratification as compared to BISAP alone. Conclusion The addition of TIPS scores to BISAP scores can enable prediction of 28-day adverse clinical outcomes with AP patients in the ED.

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Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile?

Cited by 7 publications

References 47 publications

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Tidal volume significantly affects oxygenation in healthy pigs during high-frequency oscillatory ventilation compared to conventional ventilation

Thrombo-Inflammatory Prognostic Scores Improve BISAP-Based Risk Stratification in Acute Pancreatitis Patients: A Retrospective Cohort Study

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