Pulmonary complications of acute pancreatitis

Iyer, Hariharan; Elhence, Anshuman; Mittal, Saurabh; Madan, Karan; Garg, Pramod Kumar

doi:10.1080/17476348.2020.1698951

Cited by 12 publications

(8 citation statements)

References 43 publications

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“…Intrathoracic complication is a core indicator of SAP severity and is associated with nearly 30% of pancreatitis deaths [ 5 , 16 ]. PE is one of intrathoracic complications in SAP [ 17 , 18 ]. The mechanisms of PE in AP include the following: (1) changes in capillary permeability caused by inflammation [ 19 ], (2) blockage of the pancreatic duct due to pancreatic duct injury [ 17 , 20 ], and (3) a sinus was formed between the pancreatic pseudocyst and pleural cavity [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…If PE is small and asymptomatic, it could be managed conservatively. But when there is a tappable fluid (>1 cm thickness), thoracentesis may be considered to rule out an infected PE and release the symptoms of shortness of breath [ 18 ]. Since an infected PE was undrained, fibrothorax would be developed [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…But when there is a tappable fluid (>1 cm thickness), thoracentesis may be considered to rule out an infected PE and release the symptoms of shortness of breath [ 18 ]. Since an infected PE was undrained, fibrothorax would be developed [ 18 ]. However, there are few studies on the effects and timing of IPC in SAP.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Indwelling Pleural Catheter on Severe Acute Pancreatitis: A Retrospective Study

Yao

Peng

et al. 2022

Gastroenterology Research and Practice

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Background. Pleural effusion (PE) is an important predictor for severity and prognosis of severe acute pancreatitis (SAP). However, there are few studies focused on the effects and timing of indwelling pleural catheter (IPC) on SAP. Considering this, we designed a retrospective study to verify the relationship between PE and severity of SAP and observe the effects and timing of IPC in SAP. Methods. A total of 309 SAP patients were enrolled. Based on the presence or absence of PE and IPC and IPC time, the enrolled patients were divided into 6 groups. Then, baseline parameters, disease severity, critical complications, ventilator supporting time (VST), length of stay (LOS), and 60-day mortality were compared between each two groups. Results. PE was a risk factor for death of SAP, but not an independent risk factor. SAP patients with PE rather without PE had higher critical complication rates ( p < 0.001 ), along with longer VST ( p < 0.001 ) and LOS ( p < 0.001 ). And the critical complication rates were lower in group 1 (IPC within 1 week of onset) than group 2 (IPC after 1 week of onset). Further, patients in group 1 also had shorter LOS ( p = 0.042 ) and VST ( p = 0.001 ) than those in group 2. In addition, the survival analysis showed the risk of death in the PE group was higher than the non-PE group (HR 6.6, 95% CI, 3.67–11.86, and p < 0.001 ). And the risk of death in group 1 was lower than group 2 (HR 0.26, 95% CI, 0.08–0.84, and p = 0.025 ). Conclusions. PE is a risk factor for death of SAP, but not an independent risk factor. IPC, especially IPC within 1 week of onset, has clinical practical value in SAP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of Indwelling Pleural Catheter on Severe Acute Pancreatitis: A Retrospective Study

Yao

Peng

et al. 2022

Gastroenterology Research and Practice

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“…The rate of mechanical ventilation in the FRVC group were lower than those in the non-FRVC group. Respiratory failure usually occur in the early stage of SAP 31 . A meta-analysis of aggressive fluid resuscitation for acute pancreatitis involving a total of 2626 patients showed that patients receiving aggressive IVFR treatment are at higher risk of acute respiratory distress syndrome (ARDS) 29 .…”

Section: Discussionmentioning

confidence: 99%

The impact of fluid resuscitation via colon on patients with severe acute pancreatitis

Tien

Chen

Zhao

et al. 2021

Sci Rep

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Severe acute pancreatitis (SAP) is a life-threatening disease. Fluid Resuscitation Via Colon (FRVC) may be a complementary therapy for early controlled fluid resuscitation. But its clinical application has not been reported. This study aims to explore the impact of FRVC on SAP. All SAP patients with the first onset within 72 h admitted to the hospital were included from January 2014 to December 2018 through electronic databases of Ruijin hospital and were divided into FRVC group (n = 103) and non-FRVC group (n = 78). The clinical differences before and after the therapy between the two groups were analyzed. Of the 181 patients included in the analysis, the FRVC group received more fluid volume and reached the endpoint of blood volume expansion ahead of the non-FRVC group. After the early fluid resuscitation, the inflammation indicators in the FRVC group were lower. The rate of mechanical ventilation and the incidence of hypernatremia also decreased significantly. Using pure water for FRVC was more helpful to reduce hypernatremia. However, Kaplan–Meier 90-day survival between the two groups showed no difference. These results suggest that the combination of FRVC might benefit SAP patients in the early stage of fluid resuscitation, but there is no difference between the prognosis of SAP patients and that of conventional fluid resuscitation. Further prospective study is needed to evaluate the effect of FRVC on SAP patients.

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“…This degree of rapid inflammation is so far only known in severe acute pancreatitis. 28 The morphologic correlate of pronounced pulmonary inflammation appears as diffuse interstitial oedema on CT that can affect large parts of the pulmonary tissue. 10 A recent autopsy study reported pronounced endothelial damage and widespread capillary microthrombi in COVID-19 ARDS.…”

Section: Discussionmentioning

confidence: 99%

Increased extravascular lung water index (EVLWI) reflects rapid inflammatory oedema and mortality in COVID-19 associated ARDS

Rasch

Schmidle

Sancak

et al. 2020

Preprint

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OBJECTIVE: Nearly 5 % of the patients with COVID-19 develop an acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to controls and whether EVLWI has the potential to monitor disease progression. METHODS: From the day of intubation, EVLWI, cardiac function were monitored by transpulmonary thermodilution in n=25 patients with COVID-19 and compared to a control group of 49 non-COVID-19 ARDS-patients. RESULTS: EVLWI in COVID-19-patients was noticeably elevated and significantly higher than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p<0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p=0.003) suggest inflammatory oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and mortality (23.2±6.7% vs. 30.3±6.0%, p=0.025). CONCLUSIONS: Compared to the control group, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 associated ARDS and could serve as parameter to monitor ARDS progression.

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Pulmonary complications of acute pancreatitis

Cited by 12 publications

References 43 publications

Effects of Indwelling Pleural Catheter on Severe Acute Pancreatitis: A Retrospective Study

Effects of Indwelling Pleural Catheter on Severe Acute Pancreatitis: A Retrospective Study

The impact of fluid resuscitation via colon on patients with severe acute pancreatitis

Increased extravascular lung water index (EVLWI) reflects rapid inflammatory oedema and mortality in COVID-19 associated ARDS

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