Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome

AIM:To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion(CRAI) via a drug delivery system(DDS) in severe acute pancreatitis(SAP) patients with abdominal compartment syndrome(ACS).METHODS:We presented our recent experience in 8 patients with SAP.The patients developed clinical ACS,which required abdominal decompression.During the operation,a DDS was inserted into the peripancreatic artery(the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery).Through this DDS,a protease inhibitor,antibiotics and octreotide were infused continuously.The duration of the regional artery infusion ranged from 8 to 41 d.The outcomes and the changes in the APACHE Ⅱ score,computed tomography(CT) severity index and intraabdominal pressure(IAP) of the patients were retrospectively evaluated.RESULTS:Eight patients with an initial APACHE Ⅱ score of 18.9(range,13-27) and a Balthazar CT severity index of 9.1(range,7-10) developed severe local and systemic complications.These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension(IAH).After a mean interval of 131.9 ± 72.3 d hospitalization,7 patients recovered with decreased APACHE Ⅱ scores,CT severity indexes and IAP.The mean APACHE Ⅱ score was 5.4(range,4-8),the CT severity index was 2.3(range,1-3),and IAP decreased to 7.7 mmHg(range,6-11 mmHg) 60 d after operation.One patient died of multiple organ failure 1 wk after surgery.CONCLUSION:CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.

Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units （ICUs）. A total of 108 （76.6%） questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation （APACHE）II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure （IAP）. Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over- whelming majority （88.0%） only measured lAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for lAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab- domen （92%）, worsening oliguria （80%）, and increased ventilatory support requirement （68%）. Common causes for IAH/ACS were ＂third-spacing from massive volume resuscitation in different settings＂ （88%）, ＂intra-abdominal bleeding＂, and ＂liver failure with ascites＂ （52% for both）. Though 60% respondents would recommend surgical decompression when the lAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re- spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases.