Thoracic Epidural Analgesia and Mortality in Acute Pancreatitis: A Multicenter Propensity Analysis

Jabaudon, Matthieu; Belhadj-Tahar, Nouria; Rimmelé, Thomas; Joannès-Boyau, Olivier; Bulyez, Stéphanie; Lefrant, Jean‐Yves; Malledant, Yannick; Léone, Marc; Abback, Paër-Sélim; Tamion, Fabienne; Dupont, Hervé; Lortat‐Jacob, Brice; Guerci, Philippe; Kerforne, Thomas; Cinotti, Raphaël; Jacob, Laurent; Verdier, Philippe; Dugernier, Thierry; Pereira, Bruno; Constantin, Jean-Michel

doi:10.1097/ccm.0000000000002874

Cited by 62 publications

(47 citation statements)

References 41 publications

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“…Patient data were extracted from a multicentre, retrospective, observational database involving 17 French and Belgian ICUs [10]. Patients for whom data concerning AIT with curative intent were available from ICU admission until day 30 were selected.…”

Section: Methodsmentioning

confidence: 99%

“…We used data from a large multicentre retrospective database of ICU patients with AP [10] to describe AIT use on ICU admission and during the first 30 days, evaluate between-centre variability in terms of the incidence of infections and AIT prescribing practices, evaluate outcome in terms of morbidity and mortality and identify independent risk factors evaluated on admission associated with mortality.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

et al. 2019

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BackgroundRecent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP.MethodsUsing a multicentre, retrospective (2009–2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model.ResultsIn this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02–1.05]; p < 0.0001), Balthazar score E (2.26 [1.43–3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82–4.33]; p < 0.0001), vasoactive support (2.83 [1.73–4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15–3.14]; p = 0.011), but not AIT (0.63 [0.40–1.01]; p = 0.057).ConclusionsHigh proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

et al. 2019

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“…In the face of all such data, our findings suggest that it is warranted to conduct further randomized prospective trials evaluating effect of thoracic epidural on progression of pancreatitis. In a very recent propensity analysis also a mortality reduction with thoracic epidural block was shown for patients of acute pancreatitis, although no effect on organ functions was included 19 .…”

Section: Discussionmentioning

confidence: 99%

Effect of Segmental Thoracic Epidural Block on Pancreatitis Induced Organ Dysfunction: A Preliminary Study

Tyagi

Gupta

Das

et al. 2019

Indian Journal of Critical Care Medicine

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Background This preliminary randomized controlled study evaluated effect of thoracic epidural block (TEB) on progression of acute pancreatitis induced organ dysfunction/failure. Materials and Methods Patients with predicted severe acute pancreatitis, without contraindication to TEB were randomized to receive (group TE) or not receive a TEB (group NTE) (n = 16 each). For group TE, TEB was performed at T8-9 or T9-10 vertebral level, with infusion of ropivacaine (0.2%) along with fentanyl 2 µg/mL; in group NTE, intravenous morphine was used instead, both interventions titrated to NRS of <4. SOFA score was assessed daily till discharge from ICU, and aggregate SOFA calculated by summing worst scores for each of organ system during ICU stay as primary outcome measure. Other surrogate measures of patient outcome were recorded as secondary objectives. Results Aggregate SOFA score was statistically similar between both groups (group NTE: 3 [2 - 4]; group TE: 5 [2 - 6]) ( P = 0.379); but there was trend of improvement in SOFA score in group TE versus a worsening in group NTE. Duration of hospital stay, and number of patients requiring mechanical ventilation were statistically similar; mortality was insignificantly lesser for group TE (12.5% versus 6.6%; p = 1.000). Fall in serum procalcitonin was significantly greater for group TE. Conclusion Thoracic epidural was associated with insignificant clinical trend towards better organ functions and lesser mortality; along with significantly greater fall in serum procalcitonin. These are encouraging results that could guide future use of thoracic epidural in acute pancreatitis for its non-analgesic benefits. How to cite this article Tyagi A, Gupta YR et al. Effect of Segmental Thoracic Epidural Block on Pancreatitis Induced Organ Dysfunction: A Preliminary Study. Indian J of Crit Care Med 2019;23(2):89-94.

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“…Scientific societies, charitable organisations and industrials also support clinical research. Clinical research is an asset for French intensivists with synergic and competitive networks, producing high-level studies [6,13,[16][17][18][19][20][21][22][23][24].…”

Section: Research In the Icu Environmentmentioning

confidence: 99%

French intensive care unit organisation

Léone

Constantin²,

Dahyot‐Fizelier³

et al. 2018

Anaesthesia Critical Care & Pain Medicine

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Thoracic Epidural Analgesia and Mortality in Acute Pancreatitis: A Multicenter Propensity Analysis

Cited by 62 publications

References 41 publications

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

Effect of Segmental Thoracic Epidural Block on Pancreatitis Induced Organ Dysfunction: A Preliminary Study

French intensive care unit organisation

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