title: The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. c.trepte@uke.de
authors.forename: Constantin J C
authors.initials: CJ
authors.lastname: Trepte
authors.forename: Kai A
authors.initials: KA
authors.lastname: Bachmann
authors.forename: Jan H
authors.initials: JH
authors.lastname: Stork
authors.forename: Till J
authors.initials: TJ
authors.lastname: Friedheim
authors.forename: Andrea
authors.initials: A
authors.lastname: Hinsch
authors.forename: Matthias S
authors.initials: MS
authors.lastname: Goepfert
authors.forename: Olliver
authors.initials: O
authors.lastname: Mann
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
mesh_terms: D000818:Animals; D062186:Arterial Pressure / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D004195:Disease Models, Animal; D006439:Hemodynamics / Q000502:physiology*; D008833:Microcirculation / Q000502:physiology; D010100:Oxygen / Q000378:metabolism*; D010179:Pancreas / Q000098:blood supply*; D010195:Pancreatitis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013552:Swine
chemical_list: D010100:Oxygen