Increased intra-abdominal pressure: is it of any consequence in severe acute pancreatitis?

Pupelis, Guntars; Plaudis, Haralds; Snippe, K.; Rudakovska, M.

doi:10.1080/13651820500540956

Cited by 17 publications

(15 citation statements)

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“…14 However, in the present study, we only found a significant association between an increase in IAP and a variety kinds of clinical variables related to the process of SAP, such as the need of surgical intervention, vasoactive drugs and mechanical ventilation, the presence of pathogenic microorganisms and so on which is in consistent with several previous studies. 5,7,16,17 Differently, only a correlation with the need of vasoactive drugs could be found with respect to APP which means only patients with cardiovascular dysfunction presented lower APP in the first 72 h. This might mainly be because during the early phase of SAP, most patients even those with greatly increased level of IAP are still capable to maintain a reasonable APP level through increasing the level of MAP so that they could maintain sufficient visceral perfusion to avoid severe ischemia.…”

Section: Discussionmentioning

confidence: 63%

“…Several years before, the World Society of Abdominal Compartment Syndrome (WSACS) reviewed the literature and reached a consensus about the definitions of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) 4 and the technique for the measurement of intra-abdominal pressure (IAP). So far, several studies about IAH/ACS and its clinical relevance in SAP patients have been published [5][6][7][8] and the association of elevated IAP and high occurrence rates of organ dysfunction and death has been proved for several times although most of these studies did not adopt the standard technique and definition of IAH/ACS recommended by WSACS in 2006. 4 But for abdominal perfusion pressure (APP), which is defined as mean arterial pressure (MAP) minus IAP and proposed as an accurate predictor of visceral perfusion 9 in IAH/ACS patients, no study about its clinical relevance in SAP patients has been published yet.…”

Section: Introductionmentioning

confidence: 99%

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Intra-abdominal Pressure and Abdominal Perfusion Pressure: Which is a Better Marker of Severity in Patients with Severe Acute Pancreatitis

Tong

et al. 2011

Journal of Gastrointestinal Surgery

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Intra-abdominal Pressure and Abdominal Perfusion Pressure: Which is a Better Marker of Severity in Patients with Severe Acute Pancreatitis

Tong

et al. 2011

Journal of Gastrointestinal Surgery

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“…Pupelis et al reported an elevated IAP during the first 3-5 days, and in patients with a favorable outcome a decrease from day 5 onwards [14]. De Waele et al reported that IAH developed after a median of 1 day, and was maximal on the second day.…”

Section: Introductionmentioning

confidence: 99%

Abdominal Compartment Syndrome in Severe Acute Pancreatitis – When to Decompress?

Waele

2008

Eur J Trauma Emerg Surg

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Intra-abdominal hypertension is increasingly reported in patients with severe acute pancreatitis, and is caused by several factors, including visceral edema and ascites associated with massive fluid resuscitation, paralytic ileus and retroperitoneal inflammation. There is a strong relation with early organ dysfunction and mortality in these patients, which makes intraabdominal hypertension an attractive target for intervention. Several reports conclude that this phenomenon occurs within the first 5 days after admission, and that the kinetics of IAH is important: patients with persistent IAH seem to be at the highest risk for mortality. Several strategies to reduce IAP have been developed, and given the pathophysiology, percutaneous drainage of ascites is a first logical step. However, if conservative measures fail to reduce IAP in a setting with ongoing or worsening organ dysfunction, abdominal decompression is recommended.

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“…A meta-analysis of the same group 2 years later [6] revealed that obesity (defined as a body mass index of =30 kg/m 2 ) carries a significant 2.6-fold higher risk for development of SAP, and up to a 4.6-fold higher risk for complications. Pupelis and coworkers [7] found increased intra-abdominal pressure (=25 cmH 2 O), which is related to body weight, to be a risk factor for early organ dysfunction, and therefore they recommended monitoring of intra-abdominal pressure in patients with SAP.…”

Section: Prognostic Modelsmentioning

confidence: 99%

Untitled

Gerlach

2004

Crit Care

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430CT = computed tomography; FNAB = fine needle aspiration biopsy; SAP = severe acute pancreatitis. Critical Care December 2004 Vol 8 No 6 Gerlach IntroductionSevere acute pancreatitis (SAP) can progress to a critical condition within a few hours or days after the onset of symptoms. Particularly during the early course of the disease, patients are at high risk for developing infections with subsequent multiple organ dysfunction syndrome. Therefore, early surgical intervention has been favoured, although evidence-based data are lacking. In this issue of Critical Care, De Waele and coworkers [1] present findings from a critical review conducted over nearly a decade. In contrast to many prior recommendations, the authors could not find any significant association between the timing of surgery and patient outcomes. Moreover, they identified patient age, severity of organ dysfunction at the time of surgery, and the presence of sterile necrosis as the main risk factors, and concluded that an early surgical intervention is not justified in the absence of proven infection when necrosis is detected after computed tomography (CT) scan [1]. These important findings once again raise the issue of risk assessment in the individual patient with SAP. Current practiceA major problem in the treatment of patients with SAP is the lack of randomized trials. Recently, King and coworkers [2] reported results from the first pan-European survey conducted among specialists in hepato-pancreato-biliary surgery of surgical strategies for management of SAP, with the aim being to highlight areas of discordance and thus provide a rational focus for future research. A questionnaire survey of 866 surgeons was undertaken, and the response rate was 38%. Severity stratification was used by 324 respondents (99%), with the Ranson score being the most popular. Antibiotic prophylaxis was utilized by 73%, and fine needle aspiration biopsy (FNAB) was undertaken by 53% of respondents. Furthermore, the results show that there were further aspects of practice that were concordant among AbstractPrimary or secondary infection of necrotized areas by enteral bacteria is considered a primary cause of mortality in patients with severe acute pancreatitis (SAP). Indeed, 20-30% of patients die during the course of the disease from multiple organ dysfunction after infection. This is why strategies such as antibiotic prophylaxis and early surgical intervention are appealing, but the controlled data that support these measures are insufficient. On the other hand, environmental risk factors (e.g. smoking, alcohol) and genetic predisposition have been identified; together, these led to SAP being considered a 'multifactorial' disease. However, this description does not help the intensivist to assess risk in the individual patient. A number of prognostic factors in SAP have been identified, and different scoring systems have been developed that include therapy-associated and patient-related factors. Nevertheless, at present no prognostic model is available that takes into...

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Increased intra-abdominal pressure: is it of any consequence in severe acute pancreatitis?

Abstract: Development of organ dysfunction in SAP could be associated with increased IAP. Grade III increase of IAP should be considered as an indicator for revision of treatment modalities.

Cited by 17 publications

References 26 publications

Intra-abdominal Pressure and Abdominal Perfusion Pressure: Which is a Better Marker of Severity in Patients with Severe Acute Pancreatitis

Intra-abdominal Pressure and Abdominal Perfusion Pressure: Which is a Better Marker of Severity in Patients with Severe Acute Pancreatitis

Abdominal Compartment Syndrome in Severe Acute Pancreatitis – When to Decompress?

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