Intra-Abdominal Pressure Monitoring in Acute Severe Pancreatitis—A Boon or Bane?

Abstract

Background Intra-abdominal hypertension (IAH) is increasingly reported in patients with acute pancreatitis, and is caused by visceral edema, massive fluid resuscitation, paralytic ileus, and retroperitoneal inflammation. Patients with acute severe pancreatitis actually suffer from abdominal compartment syndrome (ACS)/IAH and since there is a strong correlation between early organ dysfunction and mortality in these patients, IAH appears to be an active and attractive target for early analysis and intervention.[1] Aim The study is undertaken to estimate the significance of intra-abdominal pressure monitoring in acute severe pancreatitis. Objectives The objective of this study is to evaluate relationship between intra-abdominal pressure (IAP) and severity of acute pancreatitis and measure outcome in the form of intensive care unit (ICU) stay, hospital stay, treatment modality, and condition on discharge. Methodology A total of 50 patients diagnosed as acute severe pancreatitis were enrolled in this observational study. IAP monitoring was started on admission, once after controlling pain and then every 4 hours. IAP was measured via transvesical route. Data were collected on the length of the hospital stay, the development of systemic inflammatory response syndrome (SIRS), multiorgan failure, the extent of necrosis, the presence of infection, and mortality. Results IAH was present in 86% of patients with acute severe pancreatitis, which shows IAP monitoring is essential in managing these patients. Severity estimation by IAP monitoring is consistent with alternative laboratory parameters like Ranson’s score (p = 0.002), SIRS (p = 0.013), organ failure/multiple organ dysfunction syndrome (p = 0.009). Two deaths were incurred during the study period. Conclusions IAP measurement in acute severe pancreatitis is a cost-effective and prognostic marker. Timely diagnosis and management of IAH/ACS through IAP monitoring can prevent major comorbidity (ICU/hospital stay) and mortality.