A patient with severe acute pancreatitis successfully treated with a new critical care procedure.
It has been accepted widely that excessive humoral mediators play important roles in the pathogenesis of organ failure in patients with severe acute pancreatitis (SAP) and that infection of the pancreas due to bacterial translocation (BT) is the most frequent cause of death in SAP. On the other hand, it has been reported that continuous hemodiafiltration (CHDF) removes humoral mediators on hypercytokinemic patients such as those with systemic inflammatory response syndrome. Furthermore, several clinical studies have demonstrated that selective digestive decontamination (SDD) effectively eliminates aerobic Gram-negative bacteria from the intestinal tract and reduces the incidence of septic complications in SAP. Herein we report a case of SAP who was treated successfully with intensive care including CHDF and SDD. Thus, this case report suggests that CHDF aimed at removing causative humoral mediators and SDD for the prevention of BT are useful new tools for the management of SAP.
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan. t-moriguchi@umin.ac.jp
Takeshi
T
Moriguchi
Hiroyuki
H
Hirasawa
Shigeto
S
Oda
Hidetoshi
H
Shiga
Kazuya
K
Nakanishi
Ken-ichi
K
Matsuda
Masataka
M
Nakamura
Kennji
K
Yokohari
Takeshi
T
Hirano
Yoh
Y
Hirayama
Eizo
E
Watanabe
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000517:prevention & control*; D018988:Bacterial Translocation; D003422:Critical Care / Q000379:methods*; D006088:Gram-Negative Aerobic Bacteria / Q000302:isolation & purification / Q000502:physiology; D017583:Hemodiafiltration; D006801:Humans; D007422:Intestines / Q000382:microbiology; D008297:Male; D010195:Pancreatitis / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications