Keywords
pancreatitis
hemoperfusion
hemofiltration
continuous renal replacement therapy
fluid therapy
transpulmonary thermodilution
central venous pressure
vena cava inferior
hemoperfusion
hemofiltration
continuous renal replacement therapy
fluid therapy
transpulmonary thermodilution
central venous pressure
vena cava inferior
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Masolitin S.V., Protsenko D.N., Tyurin I.N., Mamontova O.A., Magomedov M.A., Kim T.G., Grishina L.A., Yaralyan A.V., Popov A.Y., Kalinin E.Y. 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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Abstract
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.
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