Management of Acute Pancreatitis in Critical Care Unit

Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure), purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

Dissemine intravasküler koagulasyon gelişen gram negatif sepsis hastalarında antitrombin iii ve pentoksifilin tedavilerinin karşılaştırılması

Objective: The aim of this study was to evaluate the effects of antithrombin III (AT III) and pentoxifylline treatments on the gram negative septic patients with disseminated intravascular coagulation (DIC). Method: For six days after plasma AT III activity dropped lower than 80% in Gram-patients who developed DIC were treated with AT III (90-120 IU/kg/day in 6 hours) or pentoxifylline (1.5 mg/ kg/h in 6 hours) Fibrinogen, FDP, D-dimer, complete blood count, AT III activity, and DIC scores were calculated and recorded. Results: The coagulation tests, AT III activity and FDP started to improve from the second day of treatment with both treatments (p<0.05). D-Dimer started to decrease on the second day of treatment with pentoxifylline (p<0.001) and fourth day of AT III treatment (p<0.05). Fibrinogen levels decreased on the second day of pentoxifylline treatment (p<0.05) and on the last day of AT III treatment (p<0.001). DIC scores started to decrease on the last day of treatment with AT III treatment (p<0.001) and on the third day of treatment with pentoxifylline (p<0.05). Conclusion: Both ATIII and pentoxifylline treatments had positive effects on fibrinogen, FDP, D-Dimer, AT III activity and DIC scores in patients with Gram-negative sepsis who developed DIC.Amaç: Çalışmamızda Disemine İntravasküler Koagülasyon (DİK) gelişen Gram negatif sepsis hastalarında Antitrombin III (AT III) ve Pentoksifilin tedavilerinin etkinliğini karşılaştırmayı amaçladık. Yöntem: DiK gelişen gram negatif sepsis hastalarında AT III aktivitesinin %80’in altına düştüğü günü takipeden 6 gün hastaların bir kısmına 90-20 IU/kg/gün 6 saat olacak şekilde AT III, diğer kısmına 1,5 mg/kg/saat 6 saat olucak şekilde pentoksifilin tedavisi uygulandı. Fibrinojen, FDP, D-Dimer, tam kansayımı, ATIII aktivitesive DİK skorlarına bakıldı. Bulgular: Koagülasyon testleri, AT III aktivitesi ve FDP her iki tedavi ile tedavinin 2. gününden itibaren iyileşmeye başladı (p<0,05). D-Dimer Pentoksifilin tedavisiyle tedavinin 2. gününden (p<0,001), AT III tedavisiyle 4. gününden itibaren (p<0,05) düşmeye başladı. Fibrinojen düzeyleri Pentoksifilin tedavisinin 2. günü (p<0,05), AT III tedavisinin son gününde (p<0,001) düştü. DiK skorları Pentoksifilin tedavisiyle tedavinin 3. gününde (p<0,05) AT III tedavisiyle tedavinin son gününde (p<0,001) düştü. Sonuç: olarak DİK gelişen gram negatif sepsis hastalarında AT III ve Pentoksifilin tedavilerinin her ikisininde koagülasyon testleri, Fibrinojen, FDP, D-Dimer, AT III aktivitesive ve DİK skorları üzerine olumlu etkisi vardır

Comparison and Evaluation of the Effects of Administration of Postoperative Non-Invasive Mechanical Ventilation Methods (CPAP and BIPAP) on Respiratory Mechanics and Gas Exchange in Patients Undergoing Abdominal Surgery

OBJECTIVE: The aim of our study is to investigate the effect of two different methods of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BIPAP) and oxygen support under spontaneous ventilation on respiration mechanics, gas exchange, dry mouth and face mask lesion during an early postoperative period in patients undergoing upper abdominal surgery. METHODS: Eighty patients undergoing elective abdominal surgery with laparotomy, between the age of 25 and 75 years and American Society of Anesthesiologists Physical Status score (ASA) II–III with chronic obstructive pulmonary disease (COPD) diagnosis were included to the study. Subjects were randomly allocated in to four groups. During the first postoperative hour, the first group received BIPAP, second group received high-flow CPAP, third group received low-flow CPAP and fourth group received deep breathing exercises, respiratory physiotherapy and O(2) therapy. Preoperative, postoperative before and after treatment PaO(2), PaCO(2), SpO(2), tidal volume (TV), respiratory rate (RR) levels were recorded. Subjects with dry mouth or face mask lesion were recorded. RESULTS: In all groups, PaO(2) and TV measurements were higher at the postoperative first hour than the postoperative zero hour. We found that low-flow CPAP increased PaO(2) and SpO(2) values more, and TV levels were higher in the postoperative period than the preoperative period. PaCO(2) levels were elevated at the zero hour postoperatively and at the end of the first hour; they decreased approximately to preoperative values, except in the fourth group. CONCLUSION: Administration of prophylactic respiratory support can prevent the deterioration of pulmonary functions and hypoxia in patients with COPD undergoing upper abdominal surgery. In addition, we found that low-flow CPAP had better effects on PaO(2), SpO(2), TV compared to other techniques

Supratentoryal kitlelerde cerrahi sırasında BIS kullanımının anestetik ajan tüketimi, hemodinami ve derlenme süresine etkileri

OBJECTIVE: In this study,we aimed to compare BIS monitorisation with conventional anaesthesia approach based on haemodynamic changes in terms of anaesthetic agent consumption,haemodynamic recordings,recovery time and coast. METHODS: This study was performed in 82 patients who were operated for supratentorial mass,between the ages of 20 to 60 and in the groups of ASA I or II. Cases were randomly divided in two groups in equal numbers. Group Standard Control was the group in which haemodynamic parameters were used to determine depth of anaesthesia and the Group BIS was group, in which BIS monitorisation was applied.In BIS group the BIS values was kept between 40 to 60, in control group haemodynamic changes within the range of+/-20% of initial values were interfered for appropriate anesthetic practice. Haemodynamic parameters,awakening conditions and drug usage were recorded. RESULTS: The difference between two groups in terms of eye opening moment and time of initial spontaneous breath was not statistically significant.The ‘Aldrete’ Score at postoperative 20th minute for Group BIS was significantly higher than the score calculated for the control group(p;lt;0.05). Rocuronium consumption(mg.kg-1.hr-1.) was significantly lower in Group BIS than the control group(p;lt;0.05).Although statistically significant difference(p;lt;0.05) was found between two groups in terms of initial heart rate and SpO2 values among the recorded haemodynamic changes,there was no clinically significant difference in this regard. CONCLUSION: Although using BIS monitorisation for evaluation of depth of anesthesia do not bring too much benefit versus haemodynamic parameters; it may be beneficial for selected surgeries like awake craniotomy, for patients who has the story of awareness and in the haemodynamically unstable patients.AMAÇ: Bu çalışmada standart hemodinamik esaslı anestezi yaklaşımı ile BIS monitörizasyonu eklenmiş anestezi uygulamasını, anestetik ajan tüketimi, hemodinamik parametreler, derlenme süreleri ve maliyet açısından karşılaştırmayı amaçladık. YÖNTEMLER: Çalışma, supratentoryal kitle nedeniyle ameliyat olacak, ASA I ve II grubu, 20-60 yaş arası 82 olguda yapıldı. Olgular rastlantısal olarak iki eşit gruba ayrıldı. Anestezi derinliği, Grup Standart Kontrol’de hemodinamik parametrelere göre değerlendirilirken, Grup BIS’te BIS monitörizasyonu kullanıldı. Anestezi uygulaması, BIS grubunda BIS değeri 40-60 arasında olacak şekilde, kontrol grubunda bazal değerlerin ±%20’sini aşan hemodinamik değişikliklere müdahale edilerek sağlandı. Hemodinamik parametreler, uyanma- derlenme durumu ve kullanılan ilaç miktarları kaydedildi. BULGULAR: İki grup arasında, uyanma döneminde göz açma, spontan solunum gelme süreleri açısından fark yoktu. İlaç kullanım miktarları arasında da fark saptanmadı. Derlenme döneminde izlenen 20. dk “Modifiye Alderete” skoru BIS grubunda Kontrol grubundan yüksek saptandı (p0,05). Başlangıç kalp atım hızı ve SPO2 değerleri açısından gruplar arasında anlamlı bir fark (p0,05) saptansa da, klinik olarak önemli hiçbir farklılık yoktu. SONUÇ: Anestezi derinliğini değerlendirmede hemodinamik parametrelere göre BIS kullanımı çok büyük bir avantaj getirmemekle birlikte, uyanık kraniyotomi gibi seçilmiş cerrahi girişimlerde ve öyküsünde ameliyat sırasında farkında olma yaşayan, hemodinamik riski yüksek olan hasta gruplarında BIS kullanımı daha yararlı olabilir