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.


METHODS
Prospective, case-control study.


METHODS
Intensive care unit of a university hospital.


METHODS
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.


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


METHODS
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).


CONCLUSIONS
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.
Fiedler
F
F
Institut für Anästhesiologie und Intensivmedizin, Klinikum Mannheim, Fakultät für Klinische Medizin Mannheim, Universität Heidelberg, Germany.
Jauernig
G
G
Keim
V
V
Richter
A
A
Bender
H J
HJ
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012131:Respiratory Insufficiency / Q000150:complications*; D012769:Shock / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D015282:Octreotide