An Observational Study of the Role of Intra-abdominal Pressure Monitoring in Patients With Acute Pancreatitis
An Observational Study of the Role of Intra-abdominal Pressure Monitoring in Patients With Acute Pancreatitis
Acute pancreatitis is a multi-system disease with an unpredictable clinical course and
 significant morbidity and mortality Approximately 20% of patients develop multi-organ failure
 requiring management within a critical care environment However much of the pathophysiology
 of the disease, particularly understanding why some patients develop life-threatening disease
 whilst others have a relatively benign course, remains unclear.

 It well recognised that intra-abdominal hypertension (IAH) is a cause for organ dysfunction
 in critically ill patients and is associated with higher morbidity and mortality rates
 (Sugrue et al., 1999). Abdominal compartment syndrome (defined as an increase in
 intra-abdominal pressure (IAP) >20mmHg) is associated with new organ failure (Malbrain et
 al., 2006). The mechanisms believed to contribute to IAH in acute pancreatitis include
 increased capillary permeability, hypoalbuminaemia and volume overload ("third space
 losses"), producing retroperitoneal and visceral oedema (Dambrauskas et al., 2009).

 Several small studies have recently described the link between intra-abdominal hypertension
 and adverse outcome in acute pancreatitis ( Dambrauskas et al., 2009; de Waele et al., 2005),
 however none of the authors appreciate the potential predictive value of there conclusions or
 the potential as a target for therapeutic intervention to alter the disease course.

 This study aims to study the natural history of intra-abdominal pressures in acute
 pancreatitis and determine whether they truly do have a predictive value or whether they are
 simply another marker of organ failure in a multi-system disease with notoriously poor
 outcome.
Acute pancreatitis is a multi-system disease with an unpredictable clinical course and
 significant morbidity and mortality (Wilmer, 2004). Approximately 20% of patients develop
 multi-organ failure requiring management within a critical care environment (Dambrauskas et
 al., 2009). However much of the pathophysiology of the disease, particularly understanding
 why some patients develop life-threatening disease whilst others have a relatively benign
 course, remains unclear.

 Many predictive scales have resulted from attempts to predict which patients are likely to
 develop severe disease (Imrie, Ranson, APACHE-II etc.) (Barreto & Rodriguez, 2007). However
 none of these scoring systems actually correlate clinical findings with the pathophysiology
 of the disease process, making comprehension of the rationale for the prognostic value which
 these scales have been shown to have difficult. This has lead latterly to interest in
 measurement of intra-abdominal pressures (IAP) as a potential novel method to predict outcome
 in acute pancreatitis (Buter et al., 2002) since intra-abdominal hypertension can be
 explained by the disease processes in acute pancreatitis.

 It well recognised that intra-abdominal hypertension (IAH) is a cause for organ dysfunction
 in critically ill patients and is associated with higher morbidity and mortality rates
 (Sugrue et al., 1999). Abdominal compartment syndrome (defined as an increase in IAP >20mmHg)
 is associated with new organ failure (Malbrain et al., 2006). The mechanisms believed to
 contribute to IAH in acute pancreatitis include increased capillary permeability,
 hypoalbuminaemia and volume overload ("third space losses"), producing retroperitoneal and
 visceral oedema (Dambrauskas et al., 2009).

 Several small studies have recently described the link between intra-abdominal hypertension
 and adverse outcome in acute pancreatitis ( Dambrauskas et al., 2009; de Waele et al., 2005),
 however none of the authors appreciate the potential predictive value of there conclusions or
 the potential as a target for therapeutic intervention to alter the disease course.

 This study aims to study the natural history of intra-abdominal pressures in acute
 pancreatitis and determine whether they truly do have a predictive value or whether they are
 simply another marker of organ failure in a multi-system disease with notoriously poor
 outcome.
Inclusion Criteria:

 -  All adult patients >18y.o.

 -  Diagnosis of acute pancreatitis (defined as an amylase >3 times the upper limit of
 normal and typical symptoms)

 Exclusion Criteria:

 -  Inability to provide informed consent

 -  Declines participation

 -  Uretheral catheterisation not required on clinical grounds