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Song LJ, Xiao B. Medical imaging for pancreatic diseases: Prediction of severe acute pancreatitis complicated with acute respiratory distress syndrome. World J Gastroenterol 2022; 28:6206-6212. [PMID: 36504558 PMCID: PMC9730435 DOI: 10.3748/wjg.v28.i44.6206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/15/2022] [Accepted: 11/17/2022] [Indexed: 02/06/2023] Open
Abstract
In this editorial we comment on the article published in the recent issue of the World Journal of Gastroenterology [2022; 28 (19): 2123-2136]. We pay attention to how to construct a simpler and more reliable new clinical predictive model to early identify patients at high risk of acute respiratory distress syndrome (ARDS) associated with severe acute pancreatitis (SAP), and to early predict the severity of organ failure from chest computed tomography (CT) findings in SAP patients. As we all know, SAP has a sudden onset, is a rapidly changing condition, and can be complicated with ARDS and even multiple organ dysfunction syndrome, and its mortality rate has remained high. At present, there are many clinical scoring systems for AP, including the bedside index for severity in AP, acute physiology and chronic health evaluation II, systemic inflammatory response syndrome, Japanese severe score, quick sepsis-related organ failure assessment, etc. However, some of these scoring systems are complex and require multiple and difficult clinical parameters for risk stratification. Although the aforementioned biomarkers are readily available, their ability to predict ARDS varies. Accor-dingly, it is extremely necessary to establish a simple and valuable novel model to predict the development of ARDS in AP. In addition, the extra-pancreatic manifestations of AP patients often involve the chest, among which pleural effusion and pulmonary consolidation are the more common complications. Therefore, by measuring the semi-quantitative indexes of chest CT in AP patients, such as the amount of pleural effusion and the number of lobes involved as pulmonary consolidation, it has important reference value for the early diagnosis of SAP complicated with ARDS and is expected to provide a basis for the early treatment of ARDS.
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Affiliation(s)
- Ling-Ji Song
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Bo Xiao
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Li YL, Zhang DD, Xiong YY, Wang RF, Gao XM, Gong H, Zheng SC, Wu D. Development and external validation of models to predict acute respiratory distress syndrome related to severe acute pancreatitis. World J Gastroenterol 2022; 28:2123-2136. [PMID: 35664037 PMCID: PMC9134137 DOI: 10.3748/wjg.v28.i19.2123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a major cause of death in patients with severe acute pancreatitis (SAP). Although a series of prediction models have been developed for early identification of such patients, the majority are complicated or lack validation. A simpler and more credible model is required for clinical practice.
AIM To develop and validate a predictive model for SAP related ARDS.
METHODS Patients diagnosed with AP from four hospitals located at different regions of China were retrospectively grouped into derivation and validation cohorts. Statistically significant variables were identified using the least absolute shrinkage and selection operator regression method. Predictive models with nomograms were further built using multiple logistic regression analysis with these picked predictors. The discriminatory power of new models was compared with some common models. The performance of calibration ability and clinical utility of the predictive models were evaluated.
RESULTS Out of 597 patients with AP, 139 were diagnosed with SAP (80 in derivation cohort and 59 in validation cohort) and 99 with ARDS (62 in derivation cohort and 37 in validation cohort). Four identical variables were identified as independent risk factors for both SAP and ARDS: heart rate [odds ratio (OR) = 1.05; 95%CI: 1.04-1.07; P < 0.001; OR = 1.05, 95%CI: 1.03-1.07, P < 0.001], respiratory rate (OR = 1.08, 95%CI: 1.0-1.17, P = 0.047; OR = 1.10, 95%CI: 1.02-1.19, P = 0.014), serum calcium concentration (OR = 0.26, 95%CI: 0.09-0.73, P = 0.011; OR = 0.17, 95%CI: 0.06-0.48, P = 0.001) and blood urea nitrogen (OR = 1.15, 95%CI: 1.09-1.23, P < 0.001; OR = 1.12, 95%CI: 1.05-1.19, P < 0.001). The area under receiver operating characteristic curve was 0.879 (95%CI: 0.830-0.928) and 0.898 (95%CI: 0.848-0.949) for SAP prediction in derivation and validation cohorts, respectively. This value was 0.892 (95%CI: 0.843-0.941) and 0.833 (95%CI: 0.754-0.912) for ARDS prediction, respectively. The discriminatory power of our models was improved compared with that of other widely used models and the calibration ability and clinical utility of the prediction models performed adequately.
CONCLUSION The present study constructed and validated a simple and accurate predictive model for SAP-related ARDS in patients with AP.
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Affiliation(s)
- Yun-Long Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Ding-Ding Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing 100730, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing 100730, China
| | - Yang-Yang Xiong
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Rui-Feng Wang
- Department of Gastroenterology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xiao-Mao Gao
- Department of Gastroenterology, The Sixth Hospital of Beijing, Beijing 100191, China
| | - Hui Gong
- Department of Gastroenterology, West China Longquan Hospital Sichuan University, Chengdu 610100, Sichuan Province, China
| | - Shi-Cheng Zheng
- Department of Gastroenterology, West China Longquan Hospital Sichuan University, Chengdu 610100, Sichuan Province, China
| | - Dong Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing 100730, China
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Brewer JM, Tran A, Yu J, Ali MI, Poulos CM, Gates J, Underhill D, Gluck J. Application and outcomes of extracorporeal life support in emergency general surgery and trauma. Perfusion 2021; 37:575-581. [PMID: 33878977 DOI: 10.1177/02676591211009686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We analyzed the use of Extracorporeal Membranous Oxygenation (ECMO) in acute care surgery patients at our Level-1 trauma center. We hypothesized that this patient population has improved ECMO outcomes. METHODS This was a retrospective analysis of emergency general surgery and trauma patients placed on ECMO between the periods of October 2013 and February 2020. There were 10 surgical and 12 trauma patients studied, who eventually required ECMO support. ECMO support and ECMO type/modality were analyzed with injury and survival prognostic scores examined. MAIN RESULTS Overall, 16 of the 22 patients survived to hospital discharge, for a survival rate of 73%. Mean age was 34.18 years. Mean hospital length of stay was 23.4 days with mean days on ECMO equal to 7.5. The net negative fluid balance was 5.36 L. CONCLUSIONS The survival of our ECMO cohort is notably higher than previously cited studies. Our group demonstrated decreased length of time on ECMO, decreased length of stay in the hospital, and similar rates of complications compared to prior reports. ECMO is a useful modality in acute care surgical patients and should be considered in these patient populations. Our focus on net negative fluid balance for ECMO patients demonstrates improved survival. ECMO should be considered early in surgical patients and early in advanced trauma life support.
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Affiliation(s)
- Jennifer M Brewer
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Anthony Tran
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Jielin Yu
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - M Irfan Ali
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - C M Poulos
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Jonathan Gates
- Division of Trauma and Acute Care Surgery, Hartford Healthcare, Hartford, CT, USA
| | - David Underhill
- Division of Cardiac Surgery, Hartford Healthcare, Hartford, CT, USA
| | - Jason Gluck
- Department of Cardiology and Mechanical Circulatory Support, Hartford Healthcare, Hartford, CT, USA
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Schmandt M, Glowka TR, Kreyer S, Muders T, Muenster S, Theuerkauf NU, Kalff JC, Putensen C, Schewe JC, Ehrentraut SF. Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile? J Clin Med 2021; 10:jcm10051000. [PMID: 33801239 PMCID: PMC7958117 DOI: 10.3390/jcm10051000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/04/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the feasibility of extracorporeal membrane oxygenation (ECMO) or life support (ECLS) as last resort life support therapy in patients with acute pancreatitis and subsequent secondary acute respiratory distress syndrome (ARDS). METHODS Retrospective analysis from January 2013, to April 2020, of ECMO patients with pancreatitis-induced ARDS at a German University Hospital. Demographics, hospital and ICU length of stay, duration of ECMO therapy, days on mechanical ventilation, fluid balance, need for decompressive laparotomy, amount of blood products, prognostic scores (CCI (Charlson Comorbidity Index), SOFA (Sequential Organ Failure Assessment), RESP(Respiratory ECMO Survival Prediction), SAVE (Survival after Veno-Arterial ECMO)), and the total known length of survival were assessed. RESULTS A total of n = 495 patients underwent ECMO. Eight patients with acute pancreatitis received ECLS (seven veno-venous, one veno-arterial). Five (71%) required decompressive laparotomy as salvage therapy due to abdominal hypertension. Two patients with acute pancreatitis (25%) survived to hospital discharge. The overall median length of survival was 22 days. Survivors required less fluid in the first 72 h of ECMO support and showed lower values for all prognostic scores. CONCLUSION ECLS can be performed as a rescue therapy in patients with pancreatitis and secondary ARDS, but nevertheless mortality remains still high. Thus, this last-resort therapy may be best suited for patients with fewer pre-existing comorbidities and no other organ failure.
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Affiliation(s)
- Mathias Schmandt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
| | - Tim R. Glowka
- Department of Surgery, University Hospital Bonn, 53127 Bonn, Germany; (T.R.G.); (J.C.K.)
| | - Stefan Kreyer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
| | - Thomas Muders
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
| | - Stefan Muenster
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
| | - Nils Ulrich Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
| | - Jörg C. Kalff
- Department of Surgery, University Hospital Bonn, 53127 Bonn, Germany; (T.R.G.); (J.C.K.)
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
| | - Jens-Christian Schewe
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (M.S.); (S.K.); (T.M.); (S.M.); (N.U.T.); (C.P.); (J.-C.S.)
- Correspondence: ; Tel.: +49-228-287-14118
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Stoyle G, Fawcett P, Malagon I. The use of VV-ECMO in patients with drug dependencies. J Artif Organs 2018; 21:293-299. [PMID: 29464442 DOI: 10.1007/s10047-018-1026-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/16/2018] [Indexed: 10/18/2022]
Abstract
The purpose of this study is to determine the effect of illicit drug and alcohol dependencies on mortality, length of stay, and complications in patients who have been supported with veno-venous extracorporeal membrane oxygenation (VV-ECMO) following respiratory failure not responsive to conventional methods of ventilation. 584 VV-ECMO referrals received at Wythenshawe Hospital were reviewed for evidence of drug dependency. 13 patients were identified as being drug-dependent and having undergone treatment with VV-ECMO. A matched cohort of 13 non-drug-dependent patients was identified using date of birth, pre-ECMO Murray Score, and primary diagnosis. The outcomes were compared. 19 more complications were found amongst the drug-dependent patients compared with the non-drug-dependent cohort (39 vs 20). A mean difference of 1.46 complications per patient was calculated (p = 0.005). Mortality after 180 days was reported in 4 of the drug-dependent patients, compared with one in the matched cohort. Length of stay on ECMO was increased on average by 1.93 days amongst the drug-dependent patients (p = 0.557); however, the sample size was not great enough to achieve statistical significance. Patients with drug dependencies undergoing VV-ECMO have more complications when compared with a cohort of patients with no proven or suspected drug dependencies. Differences in morbidity and mortality were not statistically significant.
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Affiliation(s)
- George Stoyle
- Wythenshawe Hospital, Manchester University Foundation Trust, Wythenshawe, Manchester, UK. .,The University of Manchester, Manchester, UK.
| | - Peter Fawcett
- Wythenshawe Hospital, Manchester University Foundation Trust, Wythenshawe, Manchester, UK
| | - Ignacio Malagon
- Wythenshawe Hospital, Manchester University Foundation Trust, Wythenshawe, Manchester, UK. .,The University of Manchester, Manchester, UK.
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Aggarwal A, Manrai M, Kochhar R. Fluid resuscitation in acute pancreatitis. World J Gastroenterol 2014; 20:18092-18103. [PMID: 25561779 PMCID: PMC4277949 DOI: 10.3748/wjg.v20.i48.18092] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/03/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount and end points of fluid replacement. Further confusion is added with the newer studies reporting better results with controlled fluid therapy. This review focuses on the pathophysiology of fluid depletion in acute pancreatitis, as well as the rationale for fluid replacement, the type, optimal amount, rate of infusion and monitoring of such patients. The basic goal of fluid epletion should be to prevent or minimize the systemic response to inflammatory markers. For this review, various studies and reviews were critically evaluated, along with authors’ recommendations, for predicted severe or severe pancreatitis based on the available evidence.
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