Mo1322 Impact of Naso-Jejunal Fluid Resuscitation in Predicted Severe Acute Pancreatitis on Necrosis, Organ Failure and Intra-Abdominal Pressure; a Randomised Comparative Study With Intravenous Ringer's Lactate

Objective: Ringer’s lactate may improve early systemic inflammation during critical illnesses like severe acute pancreatitis, which are associated with hypocalcemia. Ringer’s lactate is buffered and contains lactate and calcium. We, thus analyzed extracellular calcium or lactate’s effects on the mechanisms, intermediary markers, and organ failure in models mimicking human disease with nonesterified fatty acid (NEFA) elevation. Methods: Meta-analyses and experimental studies were performed. Experimentally, extracellular calcium and lactate were compared in their interaction with linoleic acid (LA; a NEFA increased in human severe pancreatitis), and its subsequent effects on mitochondrial depolarization and cytosolic calcium signaling resulting in cell injury. In vivo, the effect of LA was studied on organ failure, along with the effect of calcium or lactate (pH 7.4) on severe acute pancreatitis-associated organ failure. A meta-analysis of human randomized control trials comparing Ringer’s lactate to normal saline was done, focusing on necrosis and organ failure. Results: Calcium reacted ionically with LA and reduced lipotoxic necrosis. In vivo, LA induced organ failure and hypocalcemia. During severe pancreatitis, calcium supplementation in saline pH 7.4, unlike lactate, prevented hypocalcemia, increased NEFA saponification, reduced circulating NEFA and C-reactive protein, reduced pancreatic necrosis adjacent to fat necrosis, and normalized shock (carotid pulse distension) and blood urea nitrogen elevation on day 1. This, however, did not prevent the later increase in serum NEFA which caused delayed organ failure. Meta-analysis showed Ringer’s lactate reduced necrosis, but not organ failure, compared with normal saline. Conclusion: Hypocalcemia occurs due to excess NEFA binding calcium during a critical illness. Ringer’s lactate’s early benefits in systemic inflammation are by the calcium it provides reacting ionically with NEFA. This, however, does not prevent later organ failure from sustained NEFA generation. Future studies comparing calcium supplemented saline resuscitation to Ringer’s lactate may provide insights to this pathophysiology.

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Elevated intra-abdominal pressure correlates with frequency of organ failure and outcome in severe acute pancreatitis

Pancreatology ◽

10.1016/j.pan.2013.04.229 ◽

2013 ◽

Vol 13 (3) ◽

pp. S65-S66

Author(s):

Mihailo Bezmarevic ◽

Darko Mirkovic ◽

Ivan Soldatovic ◽

Milan Jovanovic

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Abdominal Pressure

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SUN-PP062: Intra-Abdominal Pressure and Organ Failure as Determinants of Nutritional Support in Patients with Severe Acute Pancreatitis

Clinical Nutrition ◽

10.1016/s0261-5614(15)30213-2 ◽

2015 ◽

Vol 34 ◽

pp. S46

Author(s):

M. Bezmarevic ◽

M. Panisic-Sekeljic ◽

I. Soldatovic ◽

A. Popadic

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Nutritional Support ◽

Abdominal Pressure

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Increased intra-abdominal pressure: is it of any consequence in severe acute pancreatitis?

HPB ◽

10.1080/13651820500540956 ◽

2006 ◽

Vol 8 (3) ◽

pp. 227-232 ◽

Cited By ~ 9

Author(s):

G. Pupelis ◽

H. Plaudis ◽

K. Snippe ◽

M. Rudakovska

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Abdominal Pressure

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Intra-Abdominal Pressure and Abdominal Perfusion Pressure Early in Severe Acute Pancreatitis Misses the Forest for the Trees

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-011-1701-9 ◽

2011 ◽

Vol 15 (12) ◽

pp. 2300-2300 ◽

Cited By ~ 1

Author(s):

Charles Joseph Miranda

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Perfusion Pressure ◽

Abdominal Pressure ◽

Abdominal Perfusion Pressure

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Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Digestion ◽

10.1159/000520892 ◽

2022 ◽

pp. 1-9

Author(s):

Daxin Guo ◽

Wei Dai ◽

Jingyi Shen ◽

Mengting Zhang ◽

Yetan Shi ◽

...

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Pancreatic Pseudocyst ◽

Meta Analysis ◽

Fluid Collection ◽

Cochrane Library ◽

Intensive Care Unit Treatment ◽

Significant Difference ◽

And Control

Background: The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. Methods: This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. Results: Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; p = 0.03) and complications (OR: 0.48; p = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; p = 0.24), mortality (OR: 0.69; p = 0.17), extrapancreatic infection (OR: 0.64, p = 0.54), pulmonary infection (OR: 1.23; p = 0.69), blood infection (OR: 0.60; p = 0.35), urinary tract infection (OR: 0.97; p = 0.97), pancreatic pseudocyst (OR: 0.59; p = 0.28), fluid collection (OR: 0.91; p = 0.76), organ failure (OR: 0.63; p = 0.19), acute respiratory distress syndrome (OR: 0.80; p = 0.61), surgical intervention (OR: 0.97; p = 0.93), dialysis (OR: 2.34; p = 0.57), use of respirator or ventilator (OR: 1.90; p = 0.40), intensive care unit treatment (OR: 2.97; p = 0.18), and additional antibiotics (OR: 0.59; p = 0.28) between the experimental and control groups. Conclusions: It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

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Abdominal compartment syndrome in severe acute pancreatitis (review of literature)

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2020-179-2-73-78 ◽

2020 ◽

Vol 179 (2) ◽

pp. 73-78

Author(s):

L. A. Otdelnov ◽

A. S. Mukhin

Keyword(s):

Acute Pancreatitis ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Severe Acute Pancreatitis ◽

Medical Management ◽

Abdominal Pressure ◽

Decompressive Laparotomy ◽

Russian Science Citation Index ◽

Abdominal Hypertension ◽

Abdominal Compartment

The study was performed for analysis of current understanding of intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis.The English and Russian articles about intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis were analyzed. The articles were found in «Russian Science Citation Index» and «PubMed».There is a pathogenetic relationship between increased intra-abdominal pressure and the development of severe acute pancreatitis.For today, it was shown that intra-abdominal hypertension in patients with severe acute pancreatitis is associated with significantly higher APACHE-II and MODS score, prevalence of pancreatic and peripancreatic tissue lesions, early infection of pancreatic necrosis and higher mortality.The article considers various variants of decompressive interventions such as decompressive laparotomy, fasciotomy and percutaneous catheter drainage. For today, there are no randomized studies devoted to researching effectiveness of different decompressive interventions.The study showed that it is necessary to regularly monitor intra-abdominal pressure in patients with severe acute pancreatitis. Patients with intra-abdominal hypertension require emergency medical management to reduce intra-abdominal pressure. Inefficiency of the medical management and development of abdominal compartment syndrome are indications for surgery. The effectiveness of different decompressive interventions requires further studies.

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