Year 2019 Vol. 27 No 3

ANESTHESIOLOGY-REANIMATOLOGY

K.V. NIKITSINA

EARLY RESPIRATORY SUPPORT IN PATIENTS WITH ACUTE NECROTIC PANCREATITIS

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To analyze the results of carrying out the early respiratory support in patients with acute necrotic pancreatitis.
Methods. 53 patients with acute necrotic pancreatitis in the fermentative phase are surveyed. Patients have been divided into 2 groups: 1 group (n=29) – patients with standard intensive therapy; 2 group (n=24) – patients who were subject to the mechanical ventilation of the lungs from the first day. Patients of both groups had a severe course of the disease (Ranson >4 points and APACHE II >11 points). The research was conducted in 3 stages: the 1st stage – on admission to the intensive care unit; the 2nd stage – 1 day afterwards, 3 stage – after 4 days. The gases indicators of the arterial blood (pCO2, pO2, pO2/FiO2, lactate) were analyzed as well as the respiratory complains, intra-abdominal pressure, duration of respiratory therapy and mortality. The received results were compared in dynamics, between groups; their interrelation was analyzed.
Results. Carrying out of early respiratory support in patients with acute necrotic pancreatitis reduces the level of intra-abdominal pressure and normalizes the respiratory index, complains and the level of lactate. Indications for early respiratory support in patients with acute necrotic pancreatitis are the following: a severe course of the disease ≥4 points on scale Ranson and ≥11 points on APACHE II scale, intra-abdominal hypertension, low level of respiratory index <300 mm hg, high indicators of lactate >3.5 mmol/l.
Conclusions. Development of intra-abdominal hypertension in patients with acute necrotic pancreatitis aggravates the indicators of the respiratory status. Early mechanical ventilation of the lungs reduces the level of intra-abdominal pressure, normalizes the respiratory status indicators in the fermentative phase.

Keywords: acute necrotic pancreatitis, mechanical ventilation of lungs, respiratory index, respiratory complains, lactate, intra-abdominal hypertension
p. 300-306 of the original issue
References
  1. Bechien UWu. Prognosis in acute pancreatitis. CMAJ. 2011 Apr 5; 183(6):673-77. doi: 10.1503/cmaj.101433
  2. Aggarwal A, Manrai M, Kochhar R. Fluid resuscitation in acute pancreatitis. World J Gastroenterol. 2014 Dec 28;20(48):18092-103. doi: 10.3748/wjg.v20.i48.18092
  3. Tezyaeva SA, Mlinnik RA, Borodkin AA. Destructive pancreatitis: our achievements or deadlock? MediAl’. 2017;(2):30-35. https://readera.ru/destruktivnyj-pankreatitnashi-dostizhenija-ili-tupik-14340165 (in Russ.)
  4. Skutova VA, Abrosimov SYu, Kasumian SA, Tchaikovskiy YuYa. Diagnosis, treatment strategy, and predictors of septic complications in necrotizing pancreatitis. Klin Mikrobiologiia i Antimikrob Khimioterapiia. 2012;14(4):351-357. http://www.antibiotic.ru/cmac/pdf/cmac.2012.t14.n4.p351.pdf (in Russ.)
  5. Beburishvili AG, Burchuladze NSh, Mazunov AS. Features of early systemic complications in patients with destructive pancreatitis. Vestn VolgGMU. 2017;(2):52-55. doi: 10.19163/1994-9480-2017-2(62)-52-55. (in Russ.)
  6. Anishchenko VV, Kim DA, Baram GI, Morozov VV, Kovgan YuM, Kan BV, Korotian AG. The substantiation of necessity the early surgical treatment of patients with heavy acute pancreatitis by the features complex. Sib Med Obozrenie. 2017;(3):43-49. doi: 10.20333/2500136-2017-3-43-49 (in Russ.)
  7. Kondratenko PG, Vasil’ev AA, Kon’kova MV. Ostryi pankreatit. Donetsk, Ukraina; 2008. 352 p. https://issuu.com/dednomto/docs/acute_pancreatitis(in Russ.).
  8. Rubenfeld GD, Herridge MS. Epidemiology and outcomes of acute lung injury. Chest. 2007 Feb;131(2):554-62. doi: 10.1378/chest.06-1976
  9. Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care. 2005 Aug;11(4):333-38. doi: 10.1097/01.ccx.0000170505.53657.48
  10. Turkevych ОМ, Pidgirnyy YaM, Zakotyanskyi ОР. Features of respiratory therapy in intra-abdominal hypertension. Meditsina Neotlozh Sostoianii. 2017;(7):45-49. doi: 10.22141/2224-0586.7.86.2017.116879 (in Ukr.)
  11. Gel’fand BR, Protsenko DN, Podachin PV, Chubchenko SV, Lapshina IIu. Sindrom abdominal’noi gipertenzii: sostoianie problemy. Meditsina Neotlozh Sostoianii. 2015;(7):41-50. http://www.mif-ua.com/archive/article/42334 (in Russ.)
  12. Maltseva LO, Mosentsev MF, Bazylenko DV, Bilan OM, Kunik LV. Respiratory Distress Syndrome: Current Issues of Definitions, Clinical Presentation, Diagnostic Algorithm. Emerg Med. 2016;4(75):108-110. doi: 10.22141/2224-0586.4.75.2016.75827
  13. Matiushko DN, Turgunov EM, Zlotnik A. Intraabdominal’naia gipertenziia i kompartment-sindrom: obzor literatury. Nauka i Zdravookhranenie. 2015;(1):22-32. https://elibrary.ru/download/elibrary_25052506_96179177.pdf (in Russ.)
  14. Romanov EI, Zubeev PS, Ryzhov MK. Bodrov AA. Risk factors of fatal outcome in pancreatonecrosis. Khirurgii im Grekova. 2014;173(4):39-42. doi: 10.24884/0042-4625-2014-173-4-39-42 (in Russ.)
  15. Litvin AA, Rebrova OYu. Decision support systems in the diagnosis and treatment of acute pancreatitis. Problemy Zdorov’ia i Ekologii. 2016;(2):10-17. https://cyberleninka.ru/article/n/sistemy-podderzhki-prinyatiya-resheniy-v-diagnostike-i-lechenii-ostrogo-pankreatita (in Russ.)
Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Anesthesiology and Resuscitation
With the Course of Advanced
Training and Retraining of Specialists.
Tel: +375 33 316-10-25,
e-mail: katarinaanaest@gmail.com,
Katsiaryna V. Nikitsina
Information about the authors:
Nikitsina Katsiaryna V, PhD, Associate Professor, Head of the Department of Anesthesiology and Resuscitation with the Course of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-4744-6838
Contacts | ©Vitebsk State Medical University, 2007-2023