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. 2007 Jan 17:2:2.
doi: 10.1186/1749-7922-2-2.

Intra-abdominal pressure in severe acute pancreatitis

Paivi Keskinen  1 , Ari Leppaniemi, Ville Pettila, Anneli Piilonen, Esko Kemppainen, Marja Hynninen
Affiliations

Intra-abdominal pressure in severe acute pancreatitis

Paivi Keskinen et al. World J Emerg Surg. .

Abstract

Background: Hospital mortality in patients with severe acute pancreatitis (SAP) remains high. Some of these patients develop increased intra-abdominal pressure (IAP) which may contribute to organ dysfunction. The aims of this study were to evaluate the frequency of increased IAP in patients with SAP and to assess the development of organ dysfunction and factors associated with high IAP.

Methods: During 2001-2003 a total of 59 patients with severe acute pancreatitis were treated in the intensive care unit (ICU) of Helsinki University Hospital. IAP was measured by the intravesical route in 37 patients with SAP. Data from these patients were retrospectively reviewed.

Results: Maximal IAP, APACHE II score, maximal SOFA score, maximal creatinine, age and maximal lactate were significantly higher in nonsurvivors. There was a significant correlation of the maximal IAP with the maximal SOFA, APACHE II, maximal creatinine, maximal lactate, base deficit and ICU length of stay. Patients were divided into quartiles according to the maximal IAP. Maximal IAP was 7-14, 15-18, 19-24 and 25-33 mmHg and the hospital mortality rate 10%, 12.5%, 22.2% and 50% in groups 1-4, respectively. A statistically significant difference was seen in the maximal SOFA, ICU length of stay, maximal creatinine and lactate values. The mean ICU-free days in groups 1-4 were 45.7, 38.8, 32.0 and 27.5 days, respectively. The difference between groups 1 and 4 was statistically significant.

Conclusion: In patients with SAP, increased IAP is associated with development of early organ failure reflected in increased mortality and fewer ICU-free days. Frequent measurement of IAP during intensive care is important in optimizing abdominal perfusion pressure and recognizing patients potentially benefitting from decompressive laparotomy.

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Figures

Figure 1
Figure 1
Correlation of maximal intra-abdominal pressure (IAP) with maximal Sequential Organ Failure Assessment (SOFA) score in survivors and nonsurvivors with severe acute pancreatitis.
Figure 2
Figure 2
Maximal intra-abdominal pressure (IAP) values, total Sequential Organ Failure Assessment (SOFA) score, cardiovascular and renal SOFA scores during ICU-days 1–7 in the survivors and nonsurvivors of severe acute pancreatitis. Dots/lines represent medians.
Figure 3
Figure 3
ROC curves for IAP max day 1–7, APACHE II and day 1 SOFA points. AUC: area under curve.
See this image and copyright information in PMC

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