Determination of Intraabdominal Pressure in Patients with Severe Acute Pancreatitis
Background. In this article, we have described the measurement of intraabdominal pressure (IAP) in a group of patients with acute severe pancreatitis (ASP). Mostly, these patients are one of the most difficult ones in the intensive care units (ICU). Anesthesiologist needs to use all possible methods of evaluating patient’s condition and also should use all treatment methods to control multiple organ failure (MOF). Usually, the severity of patient’s condition is determined by the progression of MOF, caused by endogenous intoxication and high IAP, which can easily transform to abdominal compartment syndrome (ACS). Mortality in this group of patients is very high, and the routine measurement of IAP can be used as important method of determination and prognostication of disease. One of the biggest problems of intensive care medicine and emergency surgery is diagnosis and treatment of patients with ASP. Morbidity for the last 20 years increased almost twice (10 to 80 cases in developed countries and 102 cases per 100 000 population in Ukraine). General mortality in case of ASP is 4–15 %, necrotic form — 24–60 %, postoperative mortality — 70 %. Special group of patients are those with developed MOF. Intraabdominal hypertension (IAH) is one of the causes of MOF in patients with ASP. Taking into consideration contemporary studies, there is a connection between IAH and severity of patient’s general condition. The aim of the study was to monitor and to determine the influence of epidural anesthesia and drainage of abdominal cavity on the IAP in patients with ASP. Materials and methods. We have studied 10 clinical cases (7 men, 3 women) of destructive ASP with MOF in patients, who had been treated in the ICU of Lviv Emergency Hospital. In all cases, the etiology of pancreatitis was alimental. The age of patients was from 28 to 52 years, in all of them the treatment was started in ICU within 24–48 hours after the disease onset. For IAP measurement, the intravesical route has been chosen (Kron and Iberti techniques). The results were analyzed using the scale of the World Society of the Abdominal Compartment Syndrome. Grade I: IAP 12–15 mmHg, grade II: IAP 16–20 mmHg, grade III: IAP 21–25 mmHg, grade IV: IAP > 25 mmHg. All the patients were analyzed by Ranson scale. Also, the calculation of intraabdominal perfusion pressure (IAPP) was performed. Our main purpose was to determine, if the epidural anesthesia changes the IAP. Epidural anesthesia was performed on the Th8–9 level, with epidural catheterization. We used 0.25–0.5% solution of bupivacaine. Also, the drainage of abdominal cavity was carried out for some patients using Pigtail drainage catheter. Before and after these procedures, we have measured IAP. Results. All patients with ASP suffered from increased IAP of different grades. IAPP was decreased in all cases. Epidural anesthesia reduced the IAH in the whole group, on average, by 18 %. Draining the abdominal cavity decreased IAH, on average, by 30 % in those patients to whom this procedure have been done. Conclusions. Epidural anesthesia and punctual drainage of abdominal cavity reduce IAP in patients with SAP. Effectiveness of these techniques and routine measurement of IAP in some way can show us the efficacy of treatment of patients with ASP.
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