Background: Microcirculatory disorders play a major part in the pathogenesis of acute pancreatitis. Improvement of microcirculation is hypothesized to open a therapeutic window. The aim of this study was to evaluate the effects of small-volume resuscitation in acute pancreatitis.

Methods: In rats, acute pancreatitis of graded severity was induced and pancreatic microcirculation was observed in vivo with an epiluminescent microscope. Primary outcome measures were microcirculation, leukocyte adherence, concentration of trypsinogen-activating peptide, amylase activity and histopathologic tissue damage.

Results: In necrotizing pancreatitis patients receiving prophylactic intervention with 7.5% hypertonic saline the functional capillary density was 76%. Postcapillary venular leukocyte adherence was 45% of vein cross-section. The median histopathologic damage scored 8 points. In controls, a complete microcirculatory breakdown was observed, and in the group with therapeutic intervention no significant difference was detected. In intermediate pancreatitis, the number of perfused capillaries remained 55.0 versus 23.3% in controls. Leukocyte adherence was 40.0 versus 51.7%. The histopathologic damage scored 6.0 versus 9.0 points. Trypsinogen-activating peptide concentration was reduced to 164 versus 402 nM in controls. In cerulein pancreatitis, the number of perfused capillaries was equally preserved in both groups.

Conclusion: Small-volume resuscitation preserves capillary microcirculation and prevents pancreatic injury in intermediate necrotizing pancreatitis.

Download full-text PDF

Source
http://dx.doi.org/10.1159/000212100DOI Listing

Publication Analysis

Top Keywords

small-volume resuscitation
12
leukocyte adherence
12
resuscitation preserves
8
pancreatic microcirculation
8
pancreatitis graded
8
graded severity
8
acute pancreatitis
8
trypsinogen-activating peptide
8
necrotizing pancreatitis
8
histopathologic damage
8

Similar Publications

Background: Fluid therapy is universally administered in the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin results in both lower fluid volumes and early cumulative fluid balance, and may reduce short-term mortality in patients with septic shock.

Methods: In this single centre, open label, feasibility trial; patients with early septic shock will be randomly allocated either 20% albumin for resuscitation and daily supplementation, versus buffered crystalloids alone for all fluid therapy.

View Article and Find Full Text PDF

Gunshot wounds (GSWs) to the head and neck are a common etiology of traumatic brain injury. Tangential GSWs (TGSWs) are a subset of GSWs wherein the missile penetrates tissue adjacent to the cranium, causing varying degrees of intracranial injury. Most patients sustaining TGSWs present with relatively benign neurological findings, and while a significant proportion have varying degrees of intracranial hemorrhage (ICH) on computed tomography, these tend to respond well to nonoperative management.

View Article and Find Full Text PDF

Traumatic brain injury (TBI) is a significant public health issue characterized by high mortality rates and long-term complications. This commentary examines the controversial role of the use of albumin in the fluid management of patients with severe TBI. Despite its physiological benefits, the clinical use of albumin remains controversial due to the fact that various studies have yielded mixed results.

View Article and Find Full Text PDF

ALM Resuscitation With Brain and Multiorgan Protection for Far-Forward Operations: Survival at Hypotensive Pressures.

Mil Med

August 2024

Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Queensland, Queensland 4811, Australia.

Article Synopsis
  • Non-compressible torso hemorrhagic (NCTH) shock is a leading cause of death in battlefield trauma, making the development of new resuscitation therapies essential, especially focusing on drugs like adenosine, lidocaine, and magnesium (ALM).
  • A literature review explored the effects of permissive hypotension, while a preclinical study on female pigs examined the efficacy of a fluid resuscitation protocol involving 3% NaCl with or without ALM.
  • Results indicated that achieving a mean arterial pressure (MAP) of about 50 mmHg could either be beneficial or harmful, depending on cardiac output and systemic vascular resistance, with ALM therapy improving oxygen delivery and survival rates by enhancing heart function and reducing internal bleeding.
View Article and Find Full Text PDF
Article Synopsis
  • This clinical practice guideline from the European Society of Intensive Care Medicine focuses on the choice of resuscitation fluids for critically ill adult patients, with two more parts planned to address fluid volume and removal.
  • An international panel of experts used the GRADE methodology to assess the evidence and guide their recommendations.
  • The guideline offers conditional recommendations favoring crystalloids over albumin in various patient scenarios, while also addressing specific cases with varying levels of evidence certainty, such as traumatic brain injury and cirrhosis.
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!