Octreotide treatment in patients with necrotizing pancreatitis and pulmonary failure.

OBJECTIVE

To determine the efficiency of intravenous infusion of octreotide in the treatment of patients with severe pancreatitis and pulmonary failure.

DESIGN

Prospective, case-control study.

SETTING

Intensive care unit of a university hospital.

PATIENTS

Treatment group: 39 patients with necrotizing pancreatitis were selected for the study. In all, pulmonary failure developed under conservative treatment and surgical intervention had been necessary because of local (abscess, necrosis) or systemic (systemic inflammatory response syndrome) complications. The outcome was prospectively followed up until death or discharge from the hospital.

CONTROL GROUP

54 case-control matched patients with acute necrotizing pancreatitis and pulmonary failure, who had not been treated with octreotide.

INTERVENTION

Each patient in the treatment group received 100 micrograms intravenous octreotide three times daily for 10 days, in addition to the standard intensive care therapy.

RESULTS

The groups (octreotide group, control group) were highly comparable with regard to age (mean age: 54, 51 years), sex, severity of illness (Acute Physiology and Chronic Health Evaluation II score: 27, 27), etiology of pancreatitis, and pretreatment at the time of admission to the intensive care unit. There was no difference in the development of renal, hepatic, gastrointestinal, hemostatic, neurologic, or local complications. But the frequency of the adult respiratory distress syndrome (18 vs 40%; p < 0.05) and circulatory shock (51 vs 87%; p < 0.05) was significantly lower in the treatment group. Furthermore, mortality was 26% (10 of 39 patients) in the octreotide group and 61% (33 of 54 patients) in the control group (p < 0.01).

CONCLUSION

The results of our case-control study showed a beneficial effect of octreotide in patients with severe necrotizing pancreatitis and pulmonary failure. Based on these data, a prospective, double-blind, placebo-controlled study should be performed to evaluate these results.