Management of abdominal compartment syndrome in severe acute pancreatitis patients with early continuous veno-venous hemofiltration.

BACKGROUND/AIMS: The present study investigates whether early continuous veno-venous hemofiltration (CVVH) is effective for decreasing intra-abdominal pressure (IAP) and serum TNF-α in abdominal compartment syndrome (ACS) patients of severe acute pancreatitis (SAP), and to study the correlation between IAP and serum TNF-α level.

METHODOLOGY

Twenty-five ACS patients of SAP were treated in the ICU and underwent CVVH. IAP and blood level of TNF-α were measured daily to investigate their time-course of changes and the correlation between the two parameters.

RESULTS

IAP on admission to the ICU was high (22.9±2.1 mmHg). The IAP was significantly lower (17.2±2.2 mmHg; p <0.01) 24 h after initiation of CVVH, and thereafter decreased rapidly. Mean the blood level of TNF-α was high (59.9±18.2 ng/L) on admission. However, it significantly decreased (41.1±12.8 ng/L; p <0.01) 24 h after initiation of CVVH, and subsequently decreased. There was a significant positive correlation between blood level of TNF-α and IAP (r = 0.53, p <0.01).

CONCLUSIONS

CVVH significantly decreased IAP and TNF-α in ACS patients of SAP. TNF-α was significantly correlated with IAP, suggesting that TNF-α may play an important role in the pathogenesis of ACS. Early CVVH can improve vascular permeability through elimination of cytokines such as TNF-α, and thereby decrease interstitial edema to lower IAP and should be applied in the early stages of ACS.