1
|
GÜLER Y, ÖNCEL CR. Akut Pankreatitli Hastalarda Tp-e Aralığı, Tp-e/QT Oranı and Tp-e/QTc Oranı’nın Değerlendirilmesi. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.625432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
2
|
Shanbhag ST, Choong B, Petrov M, Delahunt B, Windsor JA, Phillips ARJ. Acute pancreatitis conditioned mesenteric lymph causes cardiac dysfunction in rats independent of hypotension. Surgery 2018. [PMID: 29519557 DOI: 10.1016/j.surg.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Critical illness including severe acute pancreatitis is associated with the multiple organ dysfunction syndrome. The "gut-lymph" hypothesis states that multiple organ dysfunction syndrome is due to release of toxic factors from the intestine into the mesenteric lymph. The aims of this study were to determine the effect of normotensive acute pancreatitis conditioned mesenteric lymph on cardiac function and whether external drainage of mesenteric lymph would protect the heart. METHODS Groups of normal rats and those with normotensive taurocholate induced acute pancreatitis, had either no lymphatic intervention or thoracic duct ligation and external drainage of mesenteric lymph. After 6 hours, the hearts were removed for ex vivo functional measurements, including cardiac output, ventricular contractility (+dP/dt), and relaxation (-dP/dt). In a second experiment, mesenteric lymph from normal rats and those with established acute pancreatitis was infused into ex vivo perfused normal working rat hearts to assess impact on cardiac function. Heart and lung tissues were collected for assessment of edema. RESULTS Significant cardiac dysfunction, denoted by decreased cardiac output (21%), contractility (37%), relaxability (23%), and increased cardiac tissue edema (2-fold), developed in rats with established acute pancreatitis and no lymphatic intervention compared with the control group (all P < .05). Strikingly this cardiac dysfunction and edema was normalized in acute pancreatitis rats that had undergone prior thoracic duct ligation and external drainage of mesenteric lymph. In the second experiment, infusion of acute pancreatitis conditioned mesenteric lymph resulted in an immediate and significant similar magnitude decrease in of cardiac output (17%), contractility (22%), and relaxation (27%) compared with the infusion of normal lymph (all P <.05). CONCLUSION Mesenteric lymph from normotensive acute pancreatitis animals caused significant cardiac dysfunction which could be prevented by thoracic duct ligation and external drainage of mesenteric lymph.
Collapse
Affiliation(s)
- Satyanarayan T Shanbhag
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Bernard Choong
- Applied Surgery and Metabolism Laboratory, School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Maxim Petrov
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - John A Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand.
| | - Anthony R J Phillips
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
Song R, Yu D, Park J. Changes in gene expression of tumor necrosis factor alpha and interleukin 6 in a canine model of caerulein-induced pancreatitis. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 2016; 80:236-241. [PMID: 27408338 PMCID: PMC4924559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/01/2016] [Indexed: 06/06/2023]
Abstract
Acute pancreatitis is an inflammatory process that frequently involves peripancreatic tissues and remote organ systems. It has high morbidity and mortality rates in both human and veterinary patients. The severity of pancreatitis is generally determined by events that occur after acinar cell injury in the pancreas, resulting in elevated levels of various proinflammatory mediators, such as interleukin (IL) 1β and 6, as well as tumor necrosis factor alpha (TNF-α). When these mediators are excessively released into the systemic circulation, severe pancreatitis occurs with systemic complications. This pathophysiological process is similar to that of sepsis; thus, there are many striking clinical similarities between patients with septic shock and those with severe acute pancreatitis. We induced acute pancreatitis using caerulein in dogs and measured the change in the gene expression of proinflammatory cytokines. The levels of TNF-α and IL-6 mRNA peaked at 3 h, at twice the baseline levels, and the serum concentrations of amylase and lipase also increased. Histopathological examination revealed severe hyperemia of the pancreas and hyperemia in the duodenal villi and the hepatic sinusoid. Thus, pancreatitis can be considered an appropriate model to better understand the development of naturally occurring sepsis and to assist in the effective treatment and management of septic patients.
Collapse
Affiliation(s)
| | | | - Jinho Park
- Address all correspondence to Dr. Jinho Park; telephone: +82-63-850-0949; fax: +82-63-850-0910; e-mail:
| |
Collapse
|
4
|
Courtney Broaddus V, Berthiaume Y, Biondi JW, Matthay MA. Analytic Reviews : Hemodynamic Management of the Adult Respiratory Distress Syndrome. J Intensive Care Med 2016. [DOI: 10.1177/088506668700200404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemodynamic management is an essential aspect of the care of patients with adult respiratory distress syn drome (ARDS). On the basis of current knowledge, our proposed goals of management are to maximize pe ripheral oxygen delivery while attempting to minimize further lung damage or dysfunction. The major patho physiologic abnormalities of ARDS are an increased lung vascular permeability, right-to-left intrapulmonary shunting, and pulmonary vascular resistance. These abnormalities must be understood to select the proper therapy. Although all patients with ARDS share these abnormalities, they differ in their associated clinical conditions and underlying cardiovascular status. Be cause each ARDS patient may respond differently to therapy, hemodynamic management must be selected empirically with the goal of therapy as a guide. We have considered available therapeutic options including posi tive end-expiratory pressure, volume depletion, volume expansion, vasopressors, and vasodilators. In the future hemodynamic management of patients with ARDS will likely change as better methods of patient assessment and treatment are developed.
Collapse
Affiliation(s)
- V. Courtney Broaddus
- Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco, Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT
| | - Yves Berthiaume
- Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco, Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT,
| | - James W. Biondi
- Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco, Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT,
| | - Michael A. Matthay
- University of California, San Francisco, San Francisco, CA 94143., Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
5
|
Early hemodynamic variables and outcome in severe acute pancreatitis: a retrospective single-center cohort study. Pancreas 2013; 42:272-8. [PMID: 22982820 DOI: 10.1097/mpa.0b013e318264c9f7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to assess the association of hemodynamic factors with 90-day mortality in critically ill patients with severe acute pancreatitis (SAP). METHODS One hundred fifty-nine consecutive patients with SAP admitted to the intensive care units between January 2005 and December 2008 were included in study. We assessed the association of hemodynamic variables during the first 24 hours in the intensive care unit with 90-day mortality using multivariate analysis for all patients with SAP and for a subgroup with circulatory shock. RESULTS Advanced age (odds ratio [OR], 1.09; 95% confidence interval, 1.04-1.15 per year), higher serum creatinine (OR, 1.01; 95% confidence interval, 1.00-1.02 per unit), and lower mean arterial pressure (OR, 0.92; 95% confidence interval, 0.86-0.99 per mm Hg) were independently associated with 90-day mortality. In the subgroup of SAP with shock, higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.15; 95% confidence interval, 1.00-1.32 per point), higher central venous pressure (OR, 1.25; 95% confidence interval, 1.03-1.52 per mm Hg), and lower cardiac index (OR, 0.33; 95% confidence interval, 0.11-0.98 per L/min per m²) were independent risk factors for 90-day mortality. CONCLUSIONS Advanced age, higher serum creatinine, and lower mean arterial pressure are associated with 90-day mortality in patients with SAP. In the subgroup of patients with SAP and shock, higher Acute Physiology and Chronic Health Evaluation II score, higher central venous pressure, and lower cardiac index predicted 90-day mortality.
Collapse
|
6
|
Nadkarni N, Bhasin DK, Rana SS, Bahl A, Sinha SK, Rao C, Talwar KK. Diastolic dysfunction, prolonged QTc interval and pericardial effusion as predictors of mortality in acute pancreatitis. J Gastroenterol Hepatol 2012; 27:1576-80. [PMID: 22849657 DOI: 10.1111/j.1440-1746.2012.07229.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM The cardiac changes in acute pancreatitis have been earlier studied but the data on their prognostic significance is limited. This study was done to determine electrocardiographic (ECG) and echocardiographic changes in acute pancreatitis and determine their prognostic significance. METHODS Fifty-two consecutive patients (mean age 36.5 ± 11 years (44 males)) with acute pancreatitis and without prior cardiovascular comorbidites were prospectively enrolled and subjected to clinical, laboratory and radiological investigation. ECG and echocardiography was done at admission and during follow up. RESULTS Seventeen patients (32.7%) had mild pancreatitis and 35 (67.3%) patients had severe pancreatitis. Sinus tachycardia was the most common ECG abnormality. QTc prolongation was seen in 30/52 (57.7%) patients. On echocardiography, no patient had systolic dysfunction but 31/52 (59.6%) patients had diastolic dysfunction. All 22 patients with QTc interval < 440 ms survived compared with 8/30 patients with QTc interval ≥ 440 ms who died (P = 0.01). All eight patients who died had evidence of diastolic dysfunction (100%). None of the patients without diastolic dysfunction succumbed to illness (P = 0.02). Pericardial effusion was present in 6/52 (11.5%) patients. Of the eight patients who died, pericardial effusion was present in three (37.5%) patients and this frequency was significantly higher than that in patients who recovered (3/44 [6.8%]; P = 0.04). CONCLUSION Electrocardiographic and echocardiographic changes are seen in more than 50% of patients with acute pancreatitis. Prolonged QTc interval, pericardial effusion and diastolic dysfunction are associated with higher mortality.
Collapse
Affiliation(s)
- Nikhil Nadkarni
- Departments of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | | |
Collapse
|
7
|
Yegneswaran B, Kostis JB, Pitchumoni CS. Cardiovascular manifestations of acute pancreatitis. J Crit Care 2010; 26:225.e11-8. [PMID: 21185146 DOI: 10.1016/j.jcrc.2010.10.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/13/2010] [Accepted: 10/17/2010] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is associated with variable involvement of pancreatic/peripancreatic tissue and one or more organ systems in varying degrees. Among the multiple organ system dysfunctions in severe AP, cardiovascular and/or pulmonary manifestations are frequent. The cardiovascular system may be affected alone or with other organ systems in all stages of AP. Abnormalities of cardiac rhythm, contractility, and vasomotor tone of peripheral vessels are common cardiovascular manifestations. The pathogenetic factors of cardiac manifestations include hypovolemia and metabolic disturbances (eg, hyperkalemia, hypomagnesemia, and hypophosphatemia). Clinically, patients present with hypotension, tachycardia, and signs of systemic inflammatory response syndrome (high cardiac index, significant pulmonary shunting, decreased systemic vascular resistance, and decreased myocardial contractility). Approximately 50% of patients with AP have electrocardiographic changes, most commonly T-wave flattening and ST-segment depression. Many of the cardiac manifestations in AP are reversible with appropriate management. In AP, early onset of either multi-organ dysfunction or a sustained single-organ dysfunction is associated with poor outcome. This review highlights cardiac manifestations of AP relevant to clinical practice.
Collapse
Affiliation(s)
- Balaji Yegneswaran
- Department of Internal Medicine, Drexel University College of Medicine/Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | | | | |
Collapse
|
8
|
Isenmann R, Henne-Bruns D, Adler G. Gastrointestinal disorders of the critically ill. Shock and acute pancreatitis. Best Pract Res Clin Gastroenterol 2003; 17:345-55. [PMID: 12763500 DOI: 10.1016/s1521-6918(03)00016-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Shock and pancreatitis are closely associated. Shock can be a sequel of severe pancreatitis and systemic shock may induce pancreatitis. This chapter discusses both features with regard to their clinical and pathophysiological characteristics.
Collapse
Affiliation(s)
- Rainer Isenmann
- Department of Visceral and Transplant Surgery, University of Ulm, Steinhoevelstrasse 9, Ulm 89075, Germany
| | | | | |
Collapse
|
9
|
Abstract
OBJECTIVE To review reversible myocardial dysfunction affecting critically ill patients without cardiac pathology. DATA SOURCES The bibliography for the study was compiled through a search of different databases for the period 1966-2001. References cited in the selected articles also were reviewed. STUDY SELECTION The selection criteria included all articles published on reversible myocardial dysfunction in critically ill patients. CONCLUSIONS Reversible myocardial dysfunction may develop in a situation of critical pathology, but the etiology of reversible myocardial dysfunction is not fully understood. This dysfunction may be accompanied by increases in enzyme concentrations and electrocardiographic changes. Reversible myocardial dysfunction probably is underdiagnosed, although its presence is associated with a worsening of the prognosis and with more specific therapeutic options. Further studies are necessary to define its true incidence and clinical implications.
Collapse
Affiliation(s)
- Manuel Ruiz Bailén
- Intensive Care Unit, Critical Care and Emergencies Department, Hospital de Poniente, El Ejido, Almería, Spain
| |
Collapse
|
10
|
Affiliation(s)
- K D Lillemoe
- Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | |
Collapse
|
11
|
|
12
|
Gyöngyösi M, Takács T, Czakó L, Jambrik Z, Boda K, Farkas A, Forster T, Csanády M. Noninvasive monitoring of hemodynamic changes in acute pancreatitis in rabbits. Dig Dis Sci 1997; 42:955-61. [PMID: 9149048 DOI: 10.1023/a:1018872616400] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hemodynamic parameters of experimental acute necrotizing pancreatitis (AP) were monitored by means of echocardiography in rabbits. Left ventricular (LV) systolic and diastolic parameters were determined before and 1, 3, 6, 12, 18, and 24 hr after injection of taurocholic acid in the pancreatic duct in AP animals. Temporary LV dilatation was observed 6 hr after the AP induction [LV end-diastolic (ED) diameter from 1.16 +/- 0.04 to 1.22 +/- 0.04 cm, P < 0.05, ED volume from 2.98 +/- 0.34 to 3.57 +/- 0.75 ml, P < 0.05] without decrease in systolic function. Cardiac output (CO) and stroke volume (StV) was increased in both groups 3 hr after the operation (from 0.53 +/- 0.15 to 0.71 +/- 0.06 L/min, P < 0.05 in AP), but in the AP animals it remained high. However, 24 hr after AP induction, both the CO and the StV were decreased significantly. The LV diastolic function was impaired 1 hr after AP induction, but had recovered after 12 hr. In conclusion, an early diastolic impairment followed by LV enlargement could be noninvasively observed in experimental AP in rabbits.
Collapse
Affiliation(s)
- M Gyöngyösi
- 2nd Department of Internal Medicine, Albert Szent-Györgyi Medical University, Szeged, Hungary
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Ais G, López-Farre A, Gomez-Garre DN, Novo C, Romeo JM, Braquet P, López-Novoa JM. Role of platelet-activating factor in hemodynamic derangements in an acute rodent pancreatic model. Gastroenterology 1992; 102:181-7. [PMID: 1727752 DOI: 10.1016/0016-5085(92)91799-a] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Systemic hemodynamics were assessed in a model of experimental pancreatitis induced in rats by the retrograde injection of sodium deoxycholate, 40%, 1 mL/kg, in the pancreatic duct, using the radioactive microsphere technique before and 25 minutes after pancreatitis induction while blood pressure was stable (n = 10). A 55% decrease in cardiac out-put, a 14% decrease in heart rate, and a 3.3-fold increase in total peripheral resistances, without significant changes in blood pressure, were observed. Renal blood flow decreased by 68%. When rats were given BN-52021, a blocker of platelet-activating factor receptors (5 mg/h, IV; n = 13) coinciding with pancreatitis induction, no significant hemodynamic changes were observed. Animals treated with BN-52021 survived 89 +/- 10 minutes, whereas death occurred 67 +/- 5 minutes after pancreatitis induction in untreated rats (P less than 0.001). A different group of rats with pancreatitis showed higher blood levels of platelet-activating factor (0.28 +/- 0.06 ng/mL; n = 11) than control rats (0.16 +/- 0.03; n = 15; P less than 0.05). Very high levels of platelet-activating factor were found in peritoneal exudate from rats with pancreatitis. These data show an effective protective effect of BN-52021 on the hemodynamic impairment that follows pancreatitis induction, as well as a role of platelet-activating factor in these alterations.
Collapse
Affiliation(s)
- G Ais
- Medical Research Institute, Fundación Jimenez Diaz-Consejo Superior de Investigaciones Cientificas, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
14
|
Chardavoyne R, Asher A, Bank S, Stein TA, Wise L. Role of reactive oxygen metabolites in early cardiopulmonary changes of acute hemorrhagic pancreatitis. Dig Dis Sci 1989; 34:1581-4. [PMID: 2791809 DOI: 10.1007/bf01537114] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The role of reactive oxygen metabolites in extrapancreatic organ dysfunction associated with acute hemorrhagic pancreatitis was studied in dogs. Experimental pancreatitis was induced by the intraductal infusion of activated trypsin and taurocholate. Cardiac output, pulmonary and systemic blood pressure, pulmonary wedge pressure, central venous pressure, heart rate, blood gases and serum amylase were measured. Cardiac index, pulmonary and systemic vascular resistance, and the right and left stroke work were calculated. Systemic arterial and venous blood pressure and cardiac index gradually declined over 6 hr, while pulmonary mean blood pressure and pulmonary vascular resistance increased. Pretreatment of pancreatitis with catalase and superoxide dismutase prevented the rise in mean pulmonary blood pressure, moderated the rise in pulmonary vascular resistance, and decreased the rate and extent of the fall in cardiac index. These data suggest that reactive oxygen metabolites may play some role in the extraabdominal organ manifestations of acute pancreatitis.
Collapse
Affiliation(s)
- R Chardavoyne
- Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | | | | | | | | |
Collapse
|
15
|
Bartelink AK, Gimbrère JS, Schoots F, Dony JM. Maternal survival after acute haemorrhagic pancreatitis complicating late pregnancy. Eur J Obstet Gynecol Reprod Biol 1988; 29:41-50. [PMID: 3224742 DOI: 10.1016/0028-2243(88)90164-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the 41st week of her first pregnancy, a 25-year-old woman presented abdominal complaints. After the Caesarean delivery of an healthy child, the mother developed a severe hypoglycaemia and septic shock. Although normal serum and urine amylase values were obtained, an exploratory laparotomy disclosed acute haemorrhagic pancreatitis. Clinical treatment was complicated by repeated sepsis, multiple organ failure and ARDS, requiring the patient to receive intensive care for 3.5 months. To control abdominal sepsis and bleeding complications, an additional ten laparotomies were carried out. During this period the abdomen was kept closed by means of a nylon mesh. Although according to present day criteria the prognosis was fatal, the patient ultimately fully recovered. By exclusion, the cause of the pancreatitis was ascribed to the pregnancy itself. The medical, obstetric and surgical aspects of the management of acute pancreatitis complicating pregnancy and puerperium are reviewed.
Collapse
Affiliation(s)
- A K Bartelink
- Department of Intensive Care, St. Radboud Hospital, Nijmegen, The Netherlands
| | | | | | | |
Collapse
|
16
|
Abstract
In 16 patients with necrotizing pancreatitis and in 6 patients with edematous-interstitial pancreatitis, hemodynamic studies were conducted between the first and the 12th day after the onset of illness. Patients with necrotizing pancreatitis had a high cardiac index of 4.47 +/- 0.75 L/min X m2 and a low total peripheral vascular resistance of 884 +/- 180 dyn X s/cm5, a low mean pulmonary vascular resistance of 84.3 +/- 25.7 dyn X s/cm5, and a high pulmonary shunt fraction of 24.2% +/- 6.6% of the cardiac output. This hyperdynamic vascular pattern was not found in patients with edematous-interstitial pancreatitis associated with gallstone disease. The group of patients with edematous-interstitial pancreatitis had a cardiac index of 3.21 +/- 0.8 L/min X m2, a total peripheral vascular resistance of 1337.8 +/- 248.2 dyn X s/cm5, a mean pulmonary vascular resistance of 130.7 +/- 48.2 dyn X s/cm5, and a pulmonary shunt fraction of 13.6% +/- 3.5% of the cardiac output. There was a significant difference between the patients with necrotizing pancreatitis and those with edematous-interstitial pancreatitis in the following hemodynamic parameters: heart rate (p less than 0.02), cardiac index (p less than 0.01), total peripheral vascular resistance (p less than 0.001), arteriovenous oxygen difference (p less than 0.02), and pulmonary shunt fraction (p less than 0.01). These findings in patients with necrotizing pancreatitis demonstrate an opening of intrapulmonary shunts and peripheral vasodilatation probably due to the release of pancreatitis-associated toxic agents in the early phase of the disease.
Collapse
|
17
|
Abstract
This paper provides a review of recent advances in the understanding and management of acute pancreatitis. The mortality of acute severe pancreatitis remains disappointingly high. While there have been relatively few recent advances in the surgical management of acute pancreatitis, several nonsurgical developments appear promising.
Collapse
|
18
|
Goldfarb RD, Tambolini W, Nightingale L, Lefkowitz M, Kish P, Loegering DJ, Weber PB. Canine left ventricular function during experimental pancreatitis. J Surg Res 1985; 38:125-33. [PMID: 3968870 DOI: 10.1016/0022-4804(85)90017-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Left ventricular contractility following induction of experimental pancreatitis (EP) was studied. Contractility was evaluated by analyzing the left ventricular end systolic pressure-diameter relationship (sigma ES). Sigma ES is independent of large changes in preload, afterload, and heart rate, but sensitive to changes in ventricular contractility. Following injection of 100,000 IU trypsin in 4% taurocholate into the pancreas to induce EP, seven of eight dogs survived 5 hr. These dogs exhibited an initial significant reduction in mean arterial pressure (MABP) which stabilized at 90% of control at 3-5 hr post-EP. Cardiac output (CO) dropped slowly after EP induction (from 3.08 +/- 0.43 to 2.22 +/- 0.22 liters/min) associated with no significant change in peripheral resistance. Stroke work and stroke volume were markedly depressed reflecting the changes in MABP and CO. No consistent changes in +dP/dt or -dP/dt were observed. The ratio of endo/epicardial blood flow was unchanged as was blood Ca2+ levels throughout the experiment. Ventricular contractility as reflected by sigma ES tended to improve (from 49.7 to 69.6 mm Hg/mm at 4 hr following EP). Therefore, it was concluded that these animals exhibited no loss of ventricular contractility during EP.
Collapse
|
19
|
|
20
|
Abstract
Fifteen patients with severe pancreatitis underwent cardiovascular monitoring in an intensive care unit. The principal findings were a high cardiac index and a decrease in systemic vascular resistance. A significant negative correlation was found to exist between these two parameters (p less than 0.001). Severe pancreatitis apparently results in hemodynamic changes similar to those observed in sepsis. The mechanisms responsible for these observations are not known, although circulating vasoactive compounds resulting from pancreatic necrosis remain a strong possibility. Despite demonstrating a significant decrease in left ventricular stroke work index and an abnormal elevation in pulmonary capillary wedge pressure, the existence of a myocardial depressant factor could not be conclusively proved from these data.
Collapse
|