SUN-PP061: Gut Dysfunction in Abdominal Compartment Syndrome during Severe Acute Pancreatitis and Dilemmas in Nutritional Support

Abstract

Rationale: Enteral nutrition (EN) is a gold standard for the patients with severe acute pancreatitis (SAP), but in those with abdominal compartment syndrome (ACS) can aggravate bowel ischaemia. Total parenteral nutrition (TPN) may increase bacterial translocation and deteriorate gut functions. Methods: Study included 36 patients with SAP (21 with ACS and 15 without). Intra-abdominal pressure (IAP) was measured daily and maximal noted IAP (maxIAP) during hospitalization was included in the study. In each patient a serum level of procalcitonin (PCT) was measured daily. A value of PCT at 48 h on hospital admission and maximal noted PCT (maxPCT) during hospitalization were included. Nutritional support was EN, TPN or EN+TPN in the same time. Results: MaxIAP in patients with ACS was significant higher than in those without (p < 0.001). There were no difference in PCT values between patients with and without ACS (p = 0.64). MaxPCT in patients with ACS was 3.1 ng/mL (1.3 34.6) and in those without ACS was 2.3 ng/mL (0.4 12), (p = 0.03). In patients who received TPN 20 (95%) had ACS and 8 (53%) had not (p = 0.005). In patients who received EN 12 (57%) had ACS and 15 (100%) had not (p = 0.005). In patients who received EN+TPN in the same time 11 (52%) had ACS and 8 (53%) had not (p = 1). In patients who received TPN a significant higher PCT (p = 0.01) and maxPCT values (p < 0.001) were noted than in those who did not. In patients who received EN there was no difference in value of PCT (p = 0.06), but significant higher maxPCT value was found in patients who received EN than in those who did not (p = 0.04). No difference in PCT and maxPCT values were found in patients who received EN+TPN in the same time than in those who did not (p = 0.68, p = 0.29). Conclusion: In ACS during SAP serum values of PCT are higher in patients on TPN. Balanced usage of EN+TPN has a less influence on gut functioning than EN or TPN alone in patients with ACS and SAP.