INCREASED INTRA-ABDOMINAL PRESSURE, IS IT OF ANY CONSEQUENCE IN SEVERE ACUTE PANCREATITIS?

INTRODUCTION AND AIM: Increased intra-abdominal pressure
(IAP) is a detrimental factor for the recovery of organ function in
trauma and abdominal emergency patients. The aim of the study was
assessment of the relevance between degree of the organ dysfunction
and dynamics of IAP in patients suffering from severe acute
pancreatitis (SAP). PATIENTS AND METHODS: Management of
SAP during the years 2000–2004 was analysed retrospectively. SAP
was classified according to Atlanta 1992 criteria. All patients were
treated in the ICU. Dynamics of SIRS, organ dysfunction and
outcomes were assessed. IAP measurement was done indirectly
through the urinary bladder. RESULTS: A total of 65 patients, mean
age 47.87 years, admitted on average 2.3 days from the onset of
the disease with mean APACHE II score 6.44 were included. 34
patients received conservative treatment and 31 underwent surgical
intervention. SIRS was observed in 59 and MODS in 61 cases. IAP
was significantly higher in the 25 most complicated patients who
required renal replacement therapy (RRT), compared with 40
patients managed without RRT, 31.72 (12–70) vs 21.4 (10–78) cm
H2O, p=0.037. We observed positive interrelation with IAP
and SOFA score (r=+0.371, p50.01), number of organs involved
(r=+0.356, p50.01), liver (r=+0.305, p50.01), renal
(r=+0.167, p50.01) and pulmonary dysfunction (r=+0.153,
p50.05). IAP had negative interrelation with platelet count
(r=–0.284, p50.01) and enterally provided volume (r=–0.5,
p50.01). Mortality rate reached 9.2%. Lethality was associated with
abdominal compartment grade III. CONCLUSION: Development
of organ dysfunction in severe acute pancreatitis could be associated
with increased IAP. Grade III increase of IAP could be an indicator of
overwhelming SIRS or progressive MODS.