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

Abstract

Background: Increased intra-abdominal pressure (IAP) is detrimental for the recovery of organ function in trauma and emergency patients. The aim of this study was to assess the correlation between the dynamics of IAP and organ dysfunction in severe acute pancreatitis (SAP). Materials and Methods: Management of SAP between 2000 and 2004 was analysed. SAP was classified according to Atlanta 1992. Organ dysfunction, systemic inflammatory response syndrome (SIRS) and outcomes in relation to the IAP were assessed. IAP was measured indirectly. Results: A total of 65 patients, with an average APACHE II score of 6.44, complied with the Atlanta criteria. In all, 34 patients received conservative treatment and 31 were operated. SIRS was observed in 59 cases and multiple organ dysfunction syndrome (MODS) in 61 cases. IAP was significantly higher in the 25 most complicated patients requiring renal replacement therapy (RRT), compared with 40 patients without RRT, 31.72 vs 21.4 cm/H2O (p =0.037). IAP interrelated positively with SOFA score (r = +0.371, p <0.01) and organs involved (r = +0.356, p <0.01), and negatively with platelet count and enterally provided volume (r = -0.284, p <0.01; r = -0.5, p < 0.01, respectively). Overall mortality (9.2%) was associated with surgery and sustained increase of the IAP over 25 cm/H2O. Our data support the pathophysiological interrelation of elevated IAP and development of organ dysfunction. Conclusion: Development of organ dysfunction in SAP could be associated with increased IAP. Grade III increase of IAP should be considered as an indicator for revision of treatment modalities.