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THE IMPACT OF INTRAABDOMINAL HIPERTENSION IN OUTCOME OF SEVERE ACUTE PANCREATITIS

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Author(s): Mihaela Blaj | Ioana Grigoraș | A Ciumanghel | Irina Ristescu | Cr. Dragomir

Journal: Jurnalul de Chirurgie
ISSN 1584-9341

Volume: 7;
Issue: 4;
Start page: 596;
Date: 2011;
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Keywords: SEVERE ACUTE PANCREATITIS | INTRAABDOMINAL HYPERTANSION | ABDOMINAL COMPARTMENT SYNDROM

ABSTRACT
Background: Severe acute pancreatitis (SAP) is a condition significantly associated with morbidity and mortality, despite of therapeutic progresses. Several published papers show a high incidence of intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in SAP. IAH is both the result of progressive intraabdominal and retroperitoneal edema, and of intravascular volume therapy. SAP with IAH results in longer Intensive Care Unit (ICU) stay and higher mortality. Despite the proliferation of scoring systems for grading SAP, unfortunately, none has yet proven to be a consistently accurate predictor of the clinical course. Methods: The retrospective study enrolled patients (pts) with SAP and APACHEII>12, during a 3 years (2006-2008) period. The incidence of IAH (IAP ≥12mmHg) and ACS was recorded. IAP was monitored by measuring urinary bladder pressure .The occurrence of organ dysfunction during ICU stay was registered. Severity and prognosis were assessed by APACHE II and SOFA scores. The relationship between IAP, organic dysfunctions and mortality in PAS was analysed. Results: Out of 55 pts (the study group) 37pts (70%) had IAH at admission(18,9+/-4,48) and 9 pts (12,545%) had ACS at admission. During ICU stay 45pts (81,81%) had IAH and 29pts (52%) had ACS. Despite the high incidence of organic dysfunction in our patients, there was no correlation between IAH and organic dysfunction in the study group. APACHE II and SOFA scores were significantly higher at ICU admission, but also during ICU stay in pts with admission IAH compared to patients without admission IAH.These data lead to the idea that admission IAH is a marker of poor prognosis in SAP patients. Patients with admission IAH had a longer ICU stay (10,8+/-8,6 zile) as compared with patients without admission IAH, but the difference was not stastistically significant (p=0,400). In the study group 29pts (52,7%) died. During ICU stay 25/29 nonsurvivors (86,2%) had IAH at admision and 27/29 (93,1%) had worst IAP higher than 12mmHg. During ICU stay survivors had a worst IAP of 19,53+/-2,08, while nonsurvivors had 24,125+/-1,66 (p=0,26).Conclusions: Routine IAP monitoring at ICU admission and during ICU stay is mandatory in SAP patients because IAP strongly corelates with admission APACHE II and SOFA scores. Nonsurvivors have higher admission IAP compared with survivors and 86%of nonsurvivors had IAH at admision. We may conclude that admission IAH may signal a high degree of severity and a poor prognosis in SAP patients.

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Tangokurs Rapperswil-Jona

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