title: Intra-abdominal pressure in the early phase of severe acute pancreatitis: canary in a coal mine? Results from a rigorous validation protocol.
abstract: OBJECTIVE
  Intra-abdominal hypertension (IAH) is being increasingly reported in patients with severe acute pancreatitis (SAP) with worsened outcomes. The present study was undertaken to evaluate intra-abdominal pressure (IAP) as a marker of severity in the entire spectrum of acute pancreatitis and to ascertain the relationship between IAP and development of complications in patients with SAP.
  
  
  METHODS
  IAP was measured via the transvesical route by measurements performed at admission, once after controlling pain and then every 4 hours. Data were collected on the length of the hospital stay, the development of systemic inflammatory response syndrome (SIRS), multiorgan failure, the extent of necrosis, the presence of infection, pleural effusion, and mortality.
  
  
  RESULTS
  In total, 40 patients were enrolled and followed up for 30 days. The development of IAH was exclusively associated with SAP with an APACHE II score ≥8 and/or persistent SIRS, identifying all patients who were going to develop abdominal compartment syndrome (ACS). The presence of ACS was associated with a significantly increased extent of pancreatic necrosis, multiple organ failure, and mortality. The mean admission IAP value did not differ significantly from the value obtained after pain control or the maximum IAP measured in the first 5 days.
  
  
  CONCLUSIONS
  IAH is reliable marker of severe disease, and patients who manifest organ failure, persistent SIRS, or an Acute Physiology and Chronic health Evaluation II score ≥8 should be offered IAP surveillance. Severe pancreatitis is not a homogenous entity.
authors: Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors: Vimal
authors: V
authors: Bhandari
authors: Jiten
authors: J
authors: Jaipuria
authors: Mohit
authors: M
authors: Singh
authors: Avneet Singh
authors: AS
authors: Chawla
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009336:Necrosis / Q000209:etiology; D010179:Pancreas / Q000473:pathology*; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D010996:Pleural Effusion / Q000209:etiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology
keywords: Intra-abdominal hypertension; Pancreatitis