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Prospective evaluation of thracic-duct drainage in the treatment of respiratory failure complicating severe acute pancreatitis

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Abstract

Thoracic duct drainage (TDD) may be of value for removing toxic substances released by the inflamed pancreas and which are responsible for lung damage. We have prospectively assessed the efficacy of TDD in improving pulmonary gas exchange in 12 patients with severe acute pancreatitis (SAP) complicated by persistent respiratory failure despite standard conservative treatment including peritoneal dialysis in 8 patients. In group A were 6 patients (mean Ranson score=7.3) with adult respiratory distress syndrome (ARDS) and in group B were 6 hypoxemic patients (mean Ranson score=6.6) judged to be at risk of developing ARDS. The duration of TDD ranged from 3 to 10 days and the total amount of drained lymph (L) varied from 770 to 15 600 ml. Immunoreactive trypsin levels were significantly higher in L when compared to blood in both groups. Leukocyte myeloperoxidases in L (normal value < than 332±82 ng/ml in plasma) were increased in 5 of 5 group A patients (830±317 ng/ml) and in 3 of 6 patients in group B (671±467 ng/ml). After TDD pulmonary gas exchange as measured by median PaO2/FiO2 (mmHg) improved from 148±60 to 285±42 in group A and from 192±37 to 330±42 in group B (p<0.05). All patients were weaned after ventilation for a mean of 8 days in group A and 4 days in group B. All patients survived apart from 1 group B patient who died of sepsis on day 34. These data suggest that TDD, by allowing removal of potential mediators of lung injury is of major therapeutic value in ARDS complicating SAP. This approach may also prevent further respiratory impairment in susceptible patients.

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References

  1. Mayer AD, Mc Mahon MJ, Corfield AP, Cooper MJ, Williamson RCN, Dickson AP, Shearer MG, Imrie CW (1985) Controlled clinical trial of peritoneal lavage for treatment of severe acute pancreatitis. N Engl J Med 312:399

    Google Scholar 

  2. Reynaert MS, Bshouty ZH, Otte JB, Kestens PJ, Tremouroux J (1985) Percutaneous peritoneal dialysis as an early treatment of acute necrotic haemorrhagic pancreatitis. Intensive Care Med 11:123

    Google Scholar 

  3. Röher HD, Maroske D (1987) Timing and indication for surgical treatment in necrotizing pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg, p 321

    Google Scholar 

  4. Renner IG, Savage WT, Pantoja JL, Renner JV (1985) Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dig Dis Sci 30:1005

    Google Scholar 

  5. Buggy BP, Nostrand TT (1983) Lethal pancreatitis. Am J Gastroentereol 78:810

    Google Scholar 

  6. Köhler H, Lepsien G, Becker HD (1987) Causes of death in haemorrhagic necrotizing pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg, p 377

    Google Scholar 

  7. Balldin G (1987) Release of vasoactive substances in ascites and blood in acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg, p 63

    Google Scholar 

  8. Washaw AL, Lesser PB, Rie M, Cullen DJ (1975) The pathogenesis of pulmonary edema in acute pancreatitis. Ann Surg 182:505

    Google Scholar 

  9. Lungarella G, Gardi C, De Santi MM, Luzi P (1985) Pulmonary vascular injury in pancreatitis: evidence for a major role played by pancreatic elastase. Exp Med Pathol 42:44

    Google Scholar 

  10. Horn JK, Ranson JHC, Goldstein IM, Weissler J, Ceratola D, Taylor R, Perez HD (1980) Evidence of complement catabolism in experimental acute pancreatitis. Am J Pathol 101:205

    Google Scholar 

  11. Zieve L, Vogel WC (1961) Measurement of lecithinase A in serum and other body fluids. Serum lecithinase in acute pancreatitis. J Lab Clin Med 57:586

    Google Scholar 

  12. Mayer AD, Airey M, Hodgson J, Mc Mahon MJ (1985) Enzyme transfer from pancreas to plasma during acute pancreatitis. The contribution of ascitic fluid and lymphatic drainage of the pancreas. Gut 26:876

    Google Scholar 

  13. Sim DN, Duprez A, Anderson MC (1966) Alterations of the lymphatic circulation during acute experimental pancreatitis. Surgery 60:1175

    Google Scholar 

  14. Egdahl RH (1958) Mechanism of blood enzyme changes following production of experimental pancreatitis. Am Surg 148:389

    Google Scholar 

  15. Maunder RJ (1985) Clinical prediction of the adult respiratory distress syndrome. Clin Chest Med 6:413

    Google Scholar 

  16. Malavano R, Marchisio M, Massaglia A, Giacosa PA, Zannino M, Andriulli A, Burlina A (1980) Radioimmunoassay of trypsin-like substance in human serum. Scand J Gastroenterol 15 (Suppl 62): 3

    Google Scholar 

  17. Cullmann W, Dick W (1981) A chromogenic assay for evaluation of 378-1 level in serum and cerebrospinal fluid. J Clin Chem Clin Biochem 19:287

    Google Scholar 

  18. Deby-Dupont G, Pincemail J, Thirion A, Deby C (1987) A radioimmunoassay for polymorphonuclear leukocytes myeloperoxidase: preliminary results. Arch Int Physiol Biochim 95:S9

    Google Scholar 

  19. Starzl TE, Kaep LJ, Weil R, Halgrimson CG, Francks JJ (1979) Thoracic duct drainage in organ transplantation: will it permit better immunosuppression? Transplant Proc 11:276

    Google Scholar 

  20. Ranson JHG, Spencer FC (1978) The role of peritoneal lavage in severe acute pancreatitis. Ann Surg 187:565

    Google Scholar 

  21. Hill MC, Barkin J, Isikoff MB, Silverstein W, Kaiser M (1982) Acute pancreatitis: clinical versus CT findings. AJR 139:263

    Google Scholar 

  22. Büchler M, Uhl W, Malfertheimer P (1987) Biochemical staging of acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg, p 143

    Google Scholar 

  23. Brzek V, Bartos V (1969) Therapeutic effect of the prolonged thoracic duct fistula in patients with acute pancreatitis. Digestion 2:43

    Google Scholar 

  24. Stone HH, Fabian TC, Morris ES (1983) Failure of thoracic duct drainage to ameliorate life-threatening physiologic derangements of acute alcoholic pancreatitis. Southern Med J 76:613

    Google Scholar 

  25. Interiano B, Stuard D, Hyde RW (1972) Acute respiratory distress syndrome in pancreatitis. Ann Int Med 77:923

    Google Scholar 

  26. Machleder HI, Paulus H (1978) Clinical and immunological alterations observed in patients undergoing long-term thoracic duct drainage. Surgery 84:157

    Google Scholar 

  27. Roscher R, Beger HG (1987) Bacterial infection of pancreatic necrosis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg, p 314

    Google Scholar 

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Authors and Affiliations

  1. Department of Intensive Care Medicine, St. Luc University Hospital, Brussels, Belgium

    T. Dugernier, M. S. Reynaert, J. J. Roeseler & S. De Maeght

  2. Department of Anaesthesia, St. Luc University Hospital, Brussels, Belgium

    M. Carlier

  3. Department of Surgery, St. Luc University Hospital, Brussels, Belgium

    J. P. Squifflet & P. J. Kestens

  4. Department of Anesthesiology, Institute of Chemistry, Sart Tilman University Hospital, Liège, Belgium

    G. Deby-Dupont & M. Lamy

  5. Department of Laboratory of Biochemistry and Radiobiology, Institute of Chemistry, Sart Tilman University Hospital, Liège, Belgium

    C. Deby & J. Pincemail

Authors
  1. T. Dugernier
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  2. M. S. Reynaert
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  3. G. Deby-Dupont
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  4. J. J. Roeseler
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  5. M. Carlier
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  6. J. P. Squifflet
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  7. C. Deby
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  8. J. Pincemail
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  9. M. Lamy
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  10. S. De Maeght
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  11. P. J. Kestens
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Dugernier, T., Reynaert, M.S., Deby-Dupont, G. et al. Prospective evaluation of thracic-duct drainage in the treatment of respiratory failure complicating severe acute pancreatitis. Intensive Care Med 15, 372–378 (1989). https://doi.org/10.1007/BF00261496

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  • DOI: https://doi.org/10.1007/BF00261496

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