Evaluation of volemic status during combined extracorporeal detoxification in patients with severe acute pancreatitis: a retrospective observational study

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 (52.459.4) 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 (750-840) 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.