ABSTRACT
Objective:To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP).Methods:The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed.Results:The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×10 9/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (μg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH 2O, 1 cmH 2O≈0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY ( r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant ( P < 0.05). Conclusions:IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.
ABSTRACT
Objective To monitor intra-abdominal pressure (IAP) in critically ill patients.Methods A prospective cohort study was conducted.IAP was measured through the bladder technique.Patients were screened for intra-abdominal hypertension (IAH,IAP ≥ 12 mmHg,1 mmHg=0.133 kPa) upon ICU admission.The patients with IAH/abdominal compartment syndrome (ACS) were given appropriate treatment and management for IAH and/or ACS.Mean arterial pressure (MAP),IAP,abdominal perfusion pressure (APP),filtration gradient (FG) and serum creatinine (Cr) were determined in patients with or without IAH,as well as in survivors and non-survivors.Results The entire protocol of IAP measurement was completed in 88 patients.Number of IAH and ACS patients was 25 (28.4％) and 2 (2.3％),respectively.The number of survivors was 80 (90.9％),with 8 (9.1％) non-survivors.Compared with non-IAH patients,IAP and SCr were increased in IAH patients [IAP (mmHg):14.16 ± 2.43 vs.8.13 ± 2.28,t=10.984,P=0.000; SCr (μmol/L):126.72 ± 83.02 vs.73.41 ± 37.59,t=3.087,P=0.005],with a lower FG (mmHg:59.32 ± 17.08 vs.70.24 ± 15.03,t=-2.956,P=0.004).There were no significant differences in MAP and APP between IAH group and non-IAH group [MAP (mmHg):79.18 ± 12.33 vs.88.71 ± 17.34,t=-1.368,P=0.190; APP (mmHg):73.40 ± 16.11 vs.78.37 ± 14.32,t=-1.415,P=0.161].Compared with survivors,non-survivors showed significantly lower APP and FG [APP (mmHg):60.88 ± 14.58 vs.78.56 ± 14.06,t=3.382,P=0.001 ; FG (mmHg):50.38 ± 16.18 vs.68.81 ± 15.44,t=3.208,P=0.002],and higher SCr (μmol/L:129.12 ±83.62 vs.84.36 ± 55.15,t=-2.082,P=0.040).There was no significant difference in IAP and MAP between survivors and non-survivors [MAP (mmHg):71.00 ± 25.46 vs.84.38 ± 13.53,t =1.224,P=0.238 ; IAP (mmHg):10.62 ±5.34 vs.9.76 ± 3.40,t=-0.647,P=0.519].Conclusions Earlier IAP measurements in critically ill patients are essential for the detection of IAH/ACS and renal injury.With appropriate management of IAH/ACS,significant decrease in morbidity and mortality of patients has been achieved.