Features of correction of intra-abdominal hypertension in patients with severe course of acute pancreatitis
DOI:
https://doi.org/10.32782/2415-8127.2022.66.3Keywords:
intra-abdominal hypertension, abdominal compartment syndrome, staged treatment, асute pancreatitis.Abstract
Introduction. According to literature data, 60% of patients with severe acute pancreatitis have intra-abdominal hypertension, which leads to the development of abdominal compartment syndrome in 30% of patients and increases the mortality rate to 75%. The aim of the study was to improve the results of treatment of patients with severe acute pancreatitis by improving methods of intraabdominal hypertension correction. Materials and methods. The results of treatment of 35 patients with severe acute pancreatitis, the course of which was complicated by increased intra-abdominal pressure, were analyzed. Depending on the selected treatment tactics, the patients were divided into a comparison group (17 (48.6%) patients who were treated with traditional approaches in the diagnosis and treatment of intra-abdominal hypertension) and the main group (18 (51.7%) patients who were treated with improved staged approach). Results. The use of the proposed staged approach in the treatment of intra-abdominal hypertension in patients with a severe course of acute pancreatitis makes it possible to obtain a probable decrease in the level of intra-abdominal pressure already 24 hours after the start of treatment in comparison with the level at hospitalization (16.59±0.74 and 15.29±0.77mm Hg, p<0.05, respectively), while normal values of the indicator are reached on the sixth day of therapy (11.82±0.71 mm Hg). When analyzing the terms of the normalization of bowel function (reduction of flatulence, passing gases, independent stool), a probable difference was obtained in the studied groups, namely, in the main group the indicated clinical signs were achieved within the first week from the start of treatment in 16 (88.9%) patients, in in the comparison group – in 10 (58.8%) patients (χ2=4.1, p<0.05). Conclusions. The use of the proposed staged approach in the complex treatment of patients with severe acute pancreatitis, which is accompanied by intra-abdominal hypertension, made it possible to improve the results of treatment of this category of patients by reducing the frequency of complications from 52.9% to 16.7% (χ2=4.9, p=0.03) and total mortality from 35.3% to 5.6% (χ2=4.7, p=0.03).
References
Smit M, Koopman B, Dieperink W, Hulscher JBF, Hofker HS, van Meurs M, Zijlstra JG. Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU. Ann Intensive Care. 2020 Oct 1;10(1):130. doi: 10.1186/ s13613-020-00746-9.
Mancilla Asencio C, Berger Fleiszig Z. Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis. Medicina (Kaunas). 2022 Jun 10;58(6):785. doi: 10.3390/medicina58060785.
Caldas BS, Ascenção AMDS. PROTOCOLS FOR DIAGNOSIS AND MANAGEMENT OF INTRA-ABDOMINAL HYPERTENSION IN INTENSIVE CARE UNITS. Rev Col Bras Cir. 2020 Jan-Fev;47:e20202378. Portuguese, English. doi: 10.1590/0100-6991e-20202415.
Pereira BM. Abdominal compartment syndrome and intra-abdominal hypertension. Curr Opin Crit Care. 2019 Dec;25(6):688-696. doi: 10.1097/MCC.0000000000000665.
Xie Y, Yuan Y, Su W, Qing N, Xin H, Wang X, Tian J, Li Y, Zhu J. Effect of continuous hemofiltration on severe acute pancreatitis with different intra-abdominal pressure: A cohort study. Medicine (Baltimore). 2021 Nov 5;100(44):e27641. doi: 10.1097/MD.0000000000027641.
Kolosovych IV, Hanol IV, Cherepenko IV, Lebedieva KO, Korolova KO. Intrabdominal pressure and its correction in acute surgical pathology. Wiad Lek. 2022;75(2):372-376. PMID: 35307661.
Pereira BM. Measurement protocols and intra-abdominal hypertension treatment. Rev Col Bras Cir. 2021 Feb 15;48:e20202838. English, Portuguese. doi: 10.1590/0100-6991e-20202838.
Qu C, Gao L, Yu XQ, Wei M, Fang GQ, He J, Cao LX, Ke L, Tong ZH, Li WQ. Machine Learning Models of Acute Kidney Injury Prediction in Acute Pancreatitis Patients. Gastroenterol Res Pract. 2020 Sep 29;2020:3431290. doi: 10.1155/2020/3431290.
Rajasurya V, Surani S. Abdominal compartment syndrome: Often overlooked conditions in medical intensive care units. World J Gastroenterol. 2020 Jan 21;26(3):266-278. doi: 10.3748/wjg.v26.i3.266.
Kolosovych I., Hanol I. Estimation of the Efficiency of Draining of the Abdominal Cavity in the Complicated Course of Acute Pancreatitis. Surgery. Eastern Europe. 2022;11(1): 10-18. https://doi.org/10.34883/PI.2022.11.1.002
Kolosovych IV, Hanol IV, Cherepenko IV. Enteral tube feeding in acute pancreatitis and its complications: World of Medicine and Biology. 2021; № 4 (78): 75-9. doi: 10.26724/2079-8334-2021-4-78-75-79
Yasuda H, Kondo N, Yamamoto R, Asami S, Abe T, Tsujimoto H, Tsujimoto Y, Kataoka Y. Monitoring of gastric residual volume during enteral nutrition. Cochrane Database Syst Rev. 2021 Sep 27;9(9):CD013335. doi: 10.1002/14651858.CD013335.pub2.
