Acute Pancreatitis with Intra Abdominal Hypertension- An Airway Issue.

Acute Pancreatitis with acute intra abdominal pressure buildup is an important ICU Airway management issue from time to time. The report below brings this to our attention and while this is primarily a combined Medical / Surgical issue there are many reasons to  rethink the problem.
The recent update of general guidelines are found in the report of the working group IAP/APA Acute Pancreatitis Guidelines.

NB: These Guidelines have been reviewed in 2015

Jiten et.al. reviewed literature and have called for an update of approaches to the problem.

Complications known to occur have been listed and of course include Acute  Respiratory Failure which is approached as indicated with support by ventilation.

The issue of surgical intervention is controversial but the surgery , if done, probably should be carried out when organ failure is beginning to emerge and perhaps less than 6 hours into failure of medical therapeutic options. 

The surgery may be best carried out via a midline incision using mesh and also , importantly , the negative pressure drainage techniques now common. (1.)  This can reduce intra abdominal pressures below the 20 mm Hg level and will permit reduced compliance ventilation. This then will reduce fluid infusions necessary to maintain cardiovascular and renal support.

Conclusion:

In short the Alert from Jiten Jaipura and his team is timely and serves to refocus our attention on the criteria of the Working Group.

1. Plaudis H. et. al. Abdominal Negative Pressure Therapy: a New Method In Countering Abdominal Compartment And Peritonitis- A Prospective Study and Critical Review Of  Literature. Ann. Intensive Care2 Suppl 1 S23, 2012 PMID 23281649