The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis

TY - JOUR

T1 - The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis

AU - Trepte, Constantin J C

AU - Bachmann, Kai A

AU - Stork, Jan-Henrich

AU - Friedheim, Till J

AU - Hinsch, Andrea

AU - Goepfert, Matthias S

AU - Mann, Oliver

AU - Izbicki, Jakob R

AU - Goetz, Alwin E

AU - Reuter, Daniel A

PY - 2013/4/1

Y1 - 2013/4/1

N2 - PURPOSE: 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.

AB - PURPOSE: 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.

KW - Animals

KW - Arterial Pressure

KW - Central Venous Pressure

KW - Disease Models, Animal

KW - Hemodynamics

KW - Microcirculation

KW - Oxygen

KW - Pancreas

KW - Pancreatitis

KW - Stroke Volume

KW - Survival Analysis

KW - Swine

U2 - 10.1007/s00134-012-2775-x

DO - 10.1007/s00134-012-2775-x

M3 - SCORING: Journal article

C2 - 23287870

VL - 39

SP - 717

EP - 726

JO - INTENS CARE MED

JF - INTENS CARE MED

SN - 0342-4642

IS - 4

ER -