Acute respiratory distress syndrome in pancreatitis.

Abstract

Analysis of the records of 50 consecutive patients with acute pancreatitis admitted to a general hospital showed that 9 (18%) had diffuse pulmonary infiltrates. Dyspnea and shock were common, and arterial hypoxemia was invariably present in all patients studied (arterial PO2, 44 to 56 mm Hg). Five of the nine patients died with severe hypoxemia despite oxygen therapy. Postmortem studies showed pulmonary congestion and diffuse nonspecific pneumonitis without evidence of bacterial infection. One of the survivors had a gradual improvement in arterial oxygenation over a 4-week period. Pulmonary physiological testing 3 months later showed normal findings, except for a diffusing capacity of 50% of predicted. These findings indicate that severe hypoxemia is common in acute pancreatitis, but with appropriate care the lung disease is largely reversible. Possible pathophysiological mechanisms include injury to the lung by pancreatic enzymes, destruction or impaired synthesis of pulmonary surfactant, and pulmonary congestion secondary to myocardial failure.