Abstract:
PURPOSE:Severe acute pancreatitis (SAP) remains a life-threatening disease with classic etiology of systemic inflammatory response and mortality between 30 and 50 %. The aim of the present study is to compare two different treatment strategies of goal-directed hemodynamic management and evaluate their impact on survival, microcirculation, tissue oxygenation, and histopathologic damage in acute pancreatitis in a prospective animal study. METHODS:Thirty-four domestic pigs were randomly assigned to two different treatment groups. After induction of acute pancreatitis, in group 1 volume administration was guided by central venous pressure (CVP >12 mmHg) and mean arterial pressure (MAP). In group 2, hemodynamic management was guided primarily by left-ventricular stroke volume variation (SVV <10 %), MAP, and cardiac output (CO). Treatment according to randomization was performed for 6 h, and tissue oxygen tension in the pancreas and pancreatic microcirculation were evaluated. Thereafter, animals were observed for 7 days and then sacrificed. Standardized tissue specimens were taken post mortem, and histopathologic scoring was performed. RESULTS:Survival after 7 days was 29.4 % in group 2 versus 11.8 % in group 1 (p < 0.05). Pancreatic oxygen tension (138.0 ± 89.5 mmHg versus 71.1 ± 35.3 mmHg; p < 0.05) and pancreatic microcirculation (1,209.9 ± 630 AU versus 732 ± 315 AU; p < 0.05) were significantly higher in group 2. Significantly less histopathologic damage within the pancreas could be analyzed post mortem in group 2. CONCLUSIONS:Goal-directed hemodynamic management guided by stroke volume variation led to improved survival, tissue oxygenation, and microcirculatory perfusion, as well as less histopathologic damage in an animal model of severe acute pancreatitis.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Trepte CJ,Bachmann KA,Stork JH,Friedheim TJ,Hinsch A,Goepfert MS,Mann O,Izbicki JR,Goetz AE,Reuter DAdoi
10.1007/s00134-012-2775-xsubject
Has Abstractpub_date
2013-04-01 00:00:00pages
717-26issue
4eissn
0342-4642issn
1432-1238journal_volume
39pub_type
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journal_title:Intensive care medicine
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2009-06-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2006-07-01 00:00:00