Early continuous veno-venous haemofiltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years' experience

Pupelis, Guntars; Plaudis, Haralds; Zeiza, K.; Drozdova, Nadezda; Mukāns, Maksims; Kazaka, Ita

doi:10.1186/2110-5820-2-s1-s21

Cited by 40 publications

(29 citation statements)

References 19 publications

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“…Systemic inflammation with increase in vascular permeability leads to exsudation with inflammatory fluid accumulation in intraabdominal and retroperitoneal cavities and increase in intraabdominal pressure with resultant intraabdominal hypertension (IAH) (ref. 20 ). Abdominal compartment syndrome (ACS) is a severe complication of SAP and is significantly associated with patient prognosis.…”

Section: Pathophysiologymentioning

confidence: 99%

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Acute kidney injury following acute pancreatitis: A review

Petejová¹,

Martínek²

2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Backround. Acute kidney injury (AKI) is a common serious complication of severe acute pancreatitis (SAP) and an important marker of morbidity and mortality in critically ill septic patients. AKI due to severe acute pancreatitis can be the result of hypoxemia, release of pancreatic amylase from the injured pancreas with impairment of renal microcirculation, decrease in renal perfusion pressure due to abdominal compartment syndrome, intraabdominal hypertension or hypovolemia. Endotoxins and reactive oxygen species (ROS) also play an important role in the pathophysiology of SAP and AKI. Knowledge of the pathophysiology and diagnosis of AKI following SAP might improve the therapeutic outcome of critically ill patients. Methods and Results. An overview of the pathophysiology, diagnosis and potential treatment options based on a literature search of clinical human and experimental studies from 1987 to 2013. Conclusions. Early recognition of AKI and SAP in order to prevent severe complication like septic shock, intraabdominal hypertension or abdominal compartment syndrome leading to multiple organ dysfunction syndrome is a crucial tool of therapeutic measures in intensive care.

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Section: Pathophysiologymentioning

confidence: 99%

“…Application of CVVH in 75 of studied patients resulted in faster decrease in IAP during the first phase of the disease when IAP reached 10.6±3.9 mmHg within two weeks, while the mean IAP in patients treated without CVVH was still elevated at 12.9±4.1 mmHg (ref. 20 ).…”

Section: Intraabdominal Hypertension and Abdominal Compartment Syndromentioning

confidence: 99%

Acute kidney injury following acute pancreatitis: A review

Petejová¹,

Martínek²

2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The role of CHDF has been investigated using the polymethyl methacrylate (PMMA) membrane for the elimination of pro-inflammatory cytokines in severe AP. Pupelis et al, in a 10-year retrospective review of studies using CVVH in patients with AP, concluded that balancing the replacement of fluids and the elimination of blood cytokines resulted in a decrease in the requirement for surgical interventions from 41% to 19% [90,91]. The Japanese guidelines suggest that organ failure, but not mortality, can be prevented in severe AP.…”

Section: Other Drugsmentioning

confidence: 99%

Review of Current Evidence in Acute Pancreatitis

Varley¹,

Rossi²,

Murray³

et al. 2019

obm hg

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Acute pancreatitis (AP), an inflammatory condition of the pancreas, is one of the most common ailments of the gastrointestinal system, which results in significant morbidity and mortality. The main etiological causes of AP include alcohol consumption, gallstones, hypertriglyceridemia, and biliary stones. The clinical signs and symptoms of AP and the diagnostic criteria for this disease have been well established. Multiple scoring systems are applied to predict the severity and prognosis of AP, and the associated mortality. The present review of the literature highlights the recent significant contributions in the areas of etiology, risk factors, epidemiology, diagnosis, complications, prognosis, and the latest modalities in the treatment, which could be beneficial in the management of AP.

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“…However, the effect of furosemide alone has not been studied in a randomised setting in patients with IAH or ACS. In two retrospective analyses of patients with severe acute pancreatitis, application of RRT was associated with: 1) a negative cumulative fluid balance (approximately -1.8 L vs + 5.3 L on day 7, P < 0.001) [31]; 2) reduced incidence of IAH (31% to 14%, P < 0.01) and ACS (11% to 4%, P = 0.02) [32]; 3) reduced surgical requirements (41% to 19%, P < 0.001) [32]; and 4) a trend towards reduced mortality (12 vs 14%, non-significant) [31]. In a follow up study, Mullens et al studied nine patients with acute decompensated heart failure who did not respond to the initial medical (mainly furosemide based) treatment.…”

Section: Place For Furosemide Infusion or Renal Replacement Therapymentioning

confidence: 99%

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Regli

Keulenaer²,

Laet³

et al. 2014

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population. Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test. Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

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Early continuous veno-venous haemofiltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years' experience

Cited by 40 publications

References 19 publications

Acute kidney injury following acute pancreatitis: A review

Acute kidney injury following acute pancreatitis: A review

Review of Current Evidence in Acute Pancreatitis

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

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