Evaluation of volemic status during combined extracorporeal detoxification in patients with severe acute pancreatitis: a retrospective observational study
PDF_2022-4_111-124 (Русский)
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continuous renal replacement therapy
fluid therapy
transpulmonary thermodilution
central venous pressure
vena cava inferior

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Masolitin SV, Protsenko DN, Tyurin IN, Mamontova OA, Magomedov MA, Kim TG, Grishina LA, Yaralyan AV, Popov AY, Kalinin EY Evaluation of volemic status during combined extracorporeal detoxification in patients with severe acute pancreatitis: a retrospective observational study. Annals of Critical Care. 2022;(4):111–124. doi:10.21320/1818-474X-2022-4-111-124.


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INTRODUCTION: The morbidity and mortality of severe acute pancreatitis (SAP) remains high. Intensive therapy aimed at stopping hypovolemia, systemic endotoxicosis is a debatable problem. OBJECTIVE: Improving treatment results in patients with SAP by assessing the dynamics of volumetric criteria and the degree of fluid therapy (FT). MATERIALS AND METHODS: The study included 25 patients. First, study group of 9 patient, used standard therapy in conjunction with selective hemoperfusion and continuous veno-venous hemofiltration. Second, control group of 16 patients, who received standard intensive care. FT in the groups was 2.5–3.5 ml/kg/h. Volemic parameters were measured by transpulmonary thermodilution. The central venous pressure and the diameter of the vena cava inferior were assessed. Comparative analysis was performed between two groups. RESULTS: FT in the amount of 58.7 (52.4–59.4) ml/kg/day in group 1, and 58.3 (54.2–61.4) ml/kg/day in group 2 in the first day, up to 83.9 (72.4–86.1) and 79.3 (72.4–84.1) ml/kg/day, was observed by day 3 (p < 0.05), according to the results of transpulmonary thermodilution. From the 1st to the 3rd day, Global end-diastolic volume index increased from 345 (328–412) to 648 (590–690) ml/m2 in group 1, and from 375 (348–413) to 654 (599–701) ml/m2 in group 2 (p < 0.05). Intrathoracic blood volume index increased from 440 (420–510) to 780 (750–40) ml/m2 in group 1 and 430 (417.5–465) to 750 (665–780) ml/m2 in group 2 (p < 0.05). Extravascular lung water index and pulmonary vascular permeability index by 5 days in group 2 increased by 1.8 — 11 (10.5–11.8) and 2.2 times — 6.5 (5.75–7), respectively (p < 0.05). CONCLUSIONS: FT 3.5 ml/kg/h, reaches isovolemia by the 3rd day of therapy. The use of extracorporeal detoxification methods in complex therapy is accompanied by an improvement in clinical and laboratory parameters.

PDF_2022-4_111-124 (Русский)
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  1. Leppäniemi A., Tolonen M., Tarasconi A., et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019; 14: 27. DOI: 10.1186/s13017-019-0247-0
  2. Garg P.K., Singh V.P. Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology. 2019; 156(7): 2008–23. DOI: 10.1053/j.gastro.2018.12.041
  3. de-Madaria E., Banks P.A., Moya-Hoyo N., et al. Early factors associated with fluid sequestration and outcomes of patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2014; 12(6): 997–1002. DOI: 10.1016/j.cgh.2013.10.017
  4. Baron T.H., DiMaio C.J., Wang A.Y., Morgan K.A. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020; 158(1): 67–75.e1. DOI: 10.1053/j.gastro.2019.07.064
  5. Boxhoorn L., Voermans R.P., Bouwense S.A., et al. Acute pancreatitis [published correction appears in Lancet. 2021–398(10312): 1686]. Lancet. 2020; 396(10252): 726–34. DOI: 10.1016/S0140-6736(20)31310-6
  6. Buxbaum J.L., Quezada M., Da B., et al. Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Am J Gastroenterol. 2017; 112(5): 797–803. DOI: 10.1038/ajg.2017.40
  7. Di Martino M., Van Laarhoven S., Ielpo B., et al. Systematic review and meta-analysis of fluid therapy protocols in acute pancreatitis: type, rate and route. HPB (Oxford). 2021; 23(11): 1629–38. DOI: 10.1016/j.hpb.2021.06.426
  8. de-Madaria E., Soler-Sala G., Sánchez-Payá J., et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol. 2011; 106(10): 1843–50. DOI: 10.1038/ajg.2011.236
  9. Gad M.M., Simons-Linares C.R. Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies. World J Gastroenterol. 2020; 26(10): 1098–106. DOI: 10.3748/wjg.v26.i10.1098
  10. Koutroumpakis E., Wu B.U., Bakker O.J., et al. Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases [published correction appears in Am J Gastroenterol. 2016; 111(8): 1216. Mounzer, Rawad [added]]. Am J Gastroenterol. 2015; 110(12): 1707–16. DOI: 10.1038/ajg.2015.370
  11. Marik P.E., Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013; 41(7): 1774–81. DOI: 10.1097/CCM.0b013e31828a25fd
  12. Eskesen T.G., Wetterslev M., Perner A. Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness. Intensive Care Med. 2016; 42(3): 324–32. DOI: 10.1007/s00134-015-4168-4
  13. Vincent J.L., Rhodes A., Perel A., et al. Clinical review: Update on hemodynamic monitoring—a consensus of 16. Crit Care. 2011; 15(4): 229. DOI: 10.1186/cc10291
  14. Muller L., Bobbia X., Toumi M., et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care. 2012; 16(5): R DOI:10.1186/cc11672
  15. Кузьков В., Киров М. и др. Инвазивный мониторинг гемодинамики в интенсивной терапии и анестезиологии. Архангельск: Северный гос. мед. ун-т, 2015. [Kuzkov , Kirov M., et al. Invasive hemodynamic monitoring in intensive care and anesthesiology. Arkhangelsk: Northern State Medical University, 2015. (In Russ)]
  16. Катин М., Дзядзько А., Гурова М. и др. Оценка возможности применения метода транспульмональной термодилюции для мониторинга преднагрузки и ответа на инфузионную терапию при трансплантации печени. Гематология. Трансфузиология. Восточная Европа. 2019; 5(1). ID: 37259353. [Katin , Dzyadzko A., Gurova M., et al. Evaluation of the possibility of using the method of transpulmonary thermodilution for monitoring preload and response to infusion therapy in liver transplantation. Hematology. Transfusiology. Eastern Europe. 2019; 5(1). (In Russ)]
  17. Ma S., Zhang R., Wang S., et al. [Effect of global end diastolic volume index guidance fluid resuscitation in elderly patients with septic shock] [Article in Chinese] Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017; 29(6): 486–90. DOI: 10.3760/cma.j.issn.2095-4352.2017.06.002
  18. Banks P.A., Bollen T.L., Dervenis C., et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62(1): 102–11. DOI: 10.1136/gutjnl-2012-302779
  19. Bosslet G.T., Pope T.M., Rubenfeld G.D., et al. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med. 2015; 191(11): 1318–30. DOI: 10.1164/rccm.201505-0924ST
  20. Balthazar E.J. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002; 223(3): 603–13. DOI: 10.1148/radiol.2233010680
  21. Mao E.Q., Fei J., Peng Y.B., et al. Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chin Med J (Engl). 2010; 123(13): 1639–44.
  22. Tseng C.H., Chen T.T., Wu M.Y., et al. Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses. Crit Care. 2020; 24(1): 693. DOI: 10.1186/s13054-020-03419-y
  23. Wall I., Badalov N., Baradarian R., et al. Decreased mortality in acute pancreatitis related to early aggressive hydration. Pancreas. 2011; 40(4): 547–50. DOI: 10.1097/MPA.0b013e318215368d
  24. Abulimiti A., Husaiyin A., Sailai Y. Evaluation of HVHF for the treatment of severe acute pancreatitis accompanying MODS. Medicine (Baltimore). 2018; 97(1): e9417. DOI: 10.1097/MD.0000000000009417
  25. Guo J., Huang W., Yang X.N., et al. Short-term continuous high-volume hemofiltration on clinical outcomes of severe acute pancreatitis. Pancreas. 2014; 43(2): 250–4. DOI: 10.1097/01.mpa.0000437321.06857.fc
  26. Ronco C., Ricci Z., Husain-Syed F. From Multiple Organ Support Therapy to Extracorporeal Organ Support in Critically Ill Patients. Blood Purif. 2019; 48(2): 99–105. DOI: 10.1159/000490694
  27. Ranieri V.M., Brodie D., Vincent J.L. Extracorporeal Organ Support: From Technological Tool to Clinical Strategy Supporting Severe Organ Failure. JAMA. 2017; 318(12): 1105–6. DOI: 10.1001/jama.2017.10108
  28. Vincent J.L. Introduction to Extracorporeal Multiple Organ Support. Blood Purif. 2019; 48(2): 97–8. DOI: 10.1159/000492380
  29. Jiang H.L., Xue W.J., Li D.Q., et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol. 2005; 11(31): 4815–21. DOI: 10.3748/wjg.v11.i31.4815
  30. Chen L.X., Demirjian S., Udani S.M., et al. Cytokine Clearances in Critically Ill Patients on Continuous Renal Replacement Therapy. Blood Purif. 2018; 46(4): 315–22. DOI: 10.1159/000492025
  31. Yaroustovsky M., Abramyan M., Krotenko N., et al. A pilot study of selective lipopolysaccharide adsorption and coupled plasma filtration and adsorption in adult patients with severe sepsis. Blood Purif. 2015; 39(1–3): 210–7. DOI: 10.1159/000371754
  32. Jiang H.L., Xue W.J., Li D.Q., et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol. 2005; 11(31): 4815–21. DOI: 10.3748/wjg.v11.i31.4815
  33. Mao E.Q., Tang Y.Q., Fei J., et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl). 2009; 122(2): 169–73.
  34. Sakka S.G., Hanusch T., Thuemer O., et al. The influence of venovenous renal replacement therapy on measurements by the transpulmonary thermodilution technique. Anesth Analg. 2007; 105(4). DOI: 10.1213/01.ane.0000280440.08530.fb
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