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Background Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. Methods This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC. Results 2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response. Conclusions The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account., Author(s): Maurizio Cecconi [sup.1] , Christoph Hofer [sup.2] , Jean-Louis Teboul [sup.3] [sup.4] , Ville Pettila [sup.5] , Erika Wilkman [sup.5] , Zsolt Molnar [sup.6] , Giorgio Della Rocca [sup.7] [...]

Byline: Rita Linko (1), Marjatta Okkonen (1), Ville Pettila (2), Juha Perttila (3), Ilkka Parviainen (4), Esko Ruokonen (4), Jyrki Tenhunen (5), Tero Ala-Kokko (6), Tero Varpula (1) Keywords: Acute respiratory failure; Acute lung injury; Acute respiratory distress syndrome; Mechanical ventilation; Outcome Abstract: Objective To evaluate the incidence, treatment and mortality of acute respiratory failure (ARF) in Finnish intensive care units (ICUs). Study design Prospective multicentre cohort study. Methods All adult patients in 25 ICUs were screened for use of invasive or non-invasive ventilatory support during an 8-week period. Patients needing ventilatory support for more than 6 h were included and defined as ARF patients. Risk factors for ARF and details of prior chronic health status were assessed. Ventilatory and concomitant treatments were evaluated and recorded daily throughout the ICU stay. ICU and 90-day mortalities were assessed. Results A total of 958 (39%) from the 2,473 admitted patients were treated with ventilatory support for more than 6 h. Incidence of ARF, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) was 149.5, 10.6 and 5.0/100,000 per year, respectively. Ventilatory support was started with non-invasive interfaces in 183 of 958 (19%) patients. Ventilatory modes allowing triggering of spontaneous breaths were preferred (81%). Median tidal volume/predicted body weight was 8.7 (7.6--9.9) ml/kg and plateau pressure 19 (16--23) cm[H.sub.2]O. The 90-day mortality of ARF was 31%. Conclusions While the incidence of ARF requiring ventilatory support is higher, the incidence of ALI and ARDS seems to be lower in Finland than previously reported in other countries. Tidal volumes are higher than recommended in the concept of lung protective strategy. However, restriction of peak airway pressure was used in the majority of ARF patients. Author Affiliation: (1) Intensive Care Units, Department of Anaesthesia and Intensive Care Medicine, Division of Surgery, Helsinki University Hospital, Helsinki, Finland (2) Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Australia (3) Department of Anesthesia and Intensive Care Medicine, Turku University Hospital, Turku, Finland (4) Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland (5) Department of Intensive Care Medicine, Critical Care Medicine Research Group, Tampere University Hospital, Tampere, Finland (6) Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland Article History: Registration Date: 28/05/2009 Received Date: 14/01/2009 Accepted Date: 07/05/2009 Online Date: 13/06/2009 Article note: This article is discussed in the editorial available at: doi: 10.1007/s00134-009-1518-0. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-009-1519-z) contains supplementary material, which is available to authorized users.

Byline: Minna Niskanen (1), Matti Reinikainen (2), Ville Pettila (3) Keywords: Intensive care unit; Resource utilization; Length of stay; Outcome assessment; Benchmarking Abstract: Objectives To create a tool for benchmarking intensive care units (ICUs) with respect to case-mix adjusted length of stay (LOS) and to study the association between clinical and economic measures of ICU performance. Design Observational cohort study. Setting Twenty-three ICUs in Finland. Patients A total of 80,854 consecutive ICU admissions during 2000--2005, of which 63,304 met the inclusion criteria. Interventions None. Measurements and results Linear regression was used to create a model that predicted ICU LOS. Simplified Acute Physiology Score (SAPS) II, age, disease categories according to Acute Physiology and Chronic Health Evaluation III, single highest Therapeutic Intervention Scoring System score collected during the ICU stay and presence of other ICUs in the hospital were included in the model. Probabilities of hospital death were calculated using SAPS II, age, and disease categories as covariates. In the validation sample, the created model accounted for 28% of variation in ICU LOS across individual admissions and 64% across ICUs. The expected ICU LOS was 2.53 +- 2.24 days and the observed ICU LOS was 3.29 +- 5.37 days, P < 0.001. There was no association between the mean observed - mean expected ICU LOS and standardized mortality ratios of the ICUs (Spearman correlation 0.091, P = 0.680). Conclusions We developed a tool for the assessment of resource use in a large nationwide ICU database. It seems that there is no association between clinical and economic quality indicators. Author Affiliation: (1) Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland (2) Department of Intensive Care, North Carelia Central Hospital, Joensuu, Finland (3) Department of Anesthesiology and Intensive Care, Meilahti Hospital, Helsinki University Central Hospital, Helsinki, Finland Article History: Registration Date: 15/12/2008 Received Date: 19/12/2007 Accepted Date: 08/12/2008 Online Date: 06/01/2009 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1377-0) contains supplementary material, which is available to authorized users.

Byline: Sari Karlsson (1), Ville Pettila (2), Jyrki Tenhunen (1), Raili Laru-Sompa (3), Marja Hynninen (2), Esko Ruokonen (4) Keywords: HMGB1; Severe sepsis; Septic shock; Organ failure; Mortality; Outcome Abstract: Objective To study the predictive value of high mobility group box-1 protein (HMGB1) and hospital mortality in adult patients with severe sepsis. Study design Prospective observational cohort study in 24 ICUs in Finland. Patients Two hundred and forty-seven adult patients with severe sepsis. Measurements and main results Blood samples for HMGB1 analyses were drawn from 247 patients at baseline and from 210 patients 72a-h later. The mean APACHE II and SAPS II scores were 24 (SD 9) and 44 (SD 17), respectively. The hospital mortality was 26%. The serum HMGB1 concentrations were measured first by semi-quantitative Western immunoblotting (WB) analysis. The median HMGB1 concentration on day 0 was 108% (IQR 98.5--119) and after 72a-h 107% (IQR 98.8--120), which differed from healthy controls (97.5%, IQR 91.3--106.5 pa-=a-0.028 and 0.019, respectively). The samples were re-analysed by ELISA (in a subgroup of 170 patients) to confirm the results by WB. The median concentration in healthy controls was 0.65a-ng/ml (IQR 0.51--1.0). This was lower than in patients with severe sepsis (3.6a-ng/ml, IQR 1.9--6.5, pa- Conclusions Serum HMGB1 concentrations were elevated in patients with severe sepsis, but did not differ between survivors and non-survivors and did not predict hospital mortality. Author Affiliation: (1) Department of Intensive Care Medicine, Tampere University Hospital, Teiskontie 35, 33521, Tampere, Finland (2) Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland (3) Department of Intensive Care Medicine, Central Finland Central Hospital, Jyvaskyla, Finland (4) Department of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland Article History: Registration Date: 28/01/2008 Received Date: 14/02/2007 Accepted Date: 19/01/2008 Online Date: 23/02/2008 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1032-9) contains supplementary material, which is available to authorized users. A part of this study was presented as an abstract at the 19th Annual Congress of the European Society of Intensive Care Medicine, Barcelona, 26 September 2006. The authors wrote this article on behalf of the Finnsepsis Study Group.

Objective: Elevated blood glucose is associated with poor outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Our aim was to determine whether strict glucose control with intensive insulin treatment improves outcome of OHCA patients. Design: A randomized, controlled trial. Setting: Two university hospital intensive care units. Patients: Ninety patients resuscitated from OHCA with ventricular fibrillation detected as the initial rhythm were treated with therapeutic hypothermia. Interventions: Patients were randomized into two treatment groups: a strict glucose control group (SGC group), with a blood glucose target of 4-6 mmol/l, or a moderate glucose control group (MGC group), with a blood glucose target of 6-8 mmol/l. Both groups were treated with insulin infusion for 48 h, because a control group with no treatment was considered unethical. Measurements and results: Baseline data were similar in both groups. In the SGC group 71% of the glucose measurements were within the target range compared with 41% in the MGC group. Median glucose was 5.0 mmol/l in the SGC group and 6.4 mmol/l in the MGC group. The occurrence of moderate hypoglycemic episodes was 18% in the SGC group and 2% in the MGC group (p = 0.008). No episodes of severe hypoglycemia occurred. Mortality by day 30 was 33% in the SGC group and 35% in the MGC group (p = 0.846); the difference was 2% (95% CI -18% to +22%). Conclusions: We found no additional survival benefit from strict glucose control compared with moderate glucose control with a target between 6 and 8 mmol/l in OHCA patients. Keywords Randomized controlled trial * Resuscitation * Glucose * Hypothermia * Mortality * Enolase, Introduction One major aim of intensive care after cardiac arrest is to alleviate the hypoxic-ischemic brain injury that evolves during the reperfusion period. Several post-resuscitation factors, such as low blood [...]

Objective: To investigate the concentration of cell-free plasma DNA and its association with organ dysfunction and hospital mortality in intensive care unit patients. Design and setting: Prospective cohort study in a medical and two medical-surgical intensive care units in a university hospital. Patients: 228 critically ill patients admitted to the ICUs between January 2004 and July 2005. Measurements and results: Blood samples were collected as soon as possible after ICU admission, the following morning, and 48 h after the second sample. The cell-free plasma DNA was measured by real-time quantitative PCR assay for the β-globin gene. Physiological and mortality data were collected to the clinical database. Hospital mortality rate and SOFA scores were primary outcome measures. The maximum plasma DNA concentrations were correlated significantly with APACHE II points and with maximum SOFA scores. Cell-free plasma DNA concentrations were higher in hospital non-survivors than in survivors (median 9,366 vs. 6,506 GE/ml). Using logistic regression analysis, the maximum plasma DNA was an independent predictor of hospital mortality. Conclusions: The maximum plasma DNA concentration measured during the first 96 h of intensive care is associated with the degree of organ dysfunction and disease severity. Moreover, the maximum DNA concentration is independently associated with hospital mortality. Keywords Plasma DNA * Outcome * Critical illness * Hospital mortality * Multiple organ dysfunction, Introduction Assessing the outcome of critically ill patients is a complex process. Methods measuring the severity of illness, such as the Acute Physiology And Chronic Health Evaluation (APACHE) II [1] [...]

Byline: Sari Karlsson (1,2), Marjut Varpula (3), Esko Ruokonen (4), Ville Pettila (5), Ilkka Parviainen (4), Tero I. Ala-Kokko (6), Elina Kolho (7), Esa M. Rintala (8) Keywords: Severe sepsis; Septic shock; Incidence; Mortality; Treatment protocols Abstract: Objective To determine the incidence and outcome of severe sepsis in the adult Finnish population and to evaluate how treatment guidelines in severe sepsis are applied in clinical practice. Study design A prospective study in 24 closed multidisciplinary ICUs in 21 hospitals (4 university and 17 tertiary hospitals) in Finland. Patients All 4,500 consecutive ICU admission episodes were screened for severe sepsis during a 4-month period (1 November 2004 -- 28 February 2005). The referral population was 3,743,225. Results The severe sepsis criteria were fulfilled in 470 patients, who had472 septic episodes. The incidence of severe sepsis in the ICUs in Finland was 0.38/1000 in the adult population (95% confidence interval 0.34--0.41). The mean ICU length of stay was 8.2a-+-a-8.1a-days. ICU, hospital, and 1-year mortality rates were 15.5%, 28.3%, and 40.9%, respectively. Respiratory failure requiring ventilation support was the most common organ failure (86.2%) septic shock was present in 77% and acute renal failure in 20.6% of cases. Activated protein C was given to only 15 of the 55 patients with indication (27%) and low-dose corticosteroids to 150 of 366 (41%) patients with septic shock. Conclusions This prospective study found the incidence of ICU-treated severe sepsis in Finland to be 0.38 per 1,000 of the population. The ICU and hospital mortalities were also lower than earlier reported in United States or Australia. Evidence-based sepsis therapies were not used as often as recommended. Author Affiliation: (1) Aurinkokatu 3B38, 13100, Hameenlinna, Finland (2) Division of Intensive Care, Tampere University Hospital, Tampere, Finland (3) Division of Intensive Care, Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland (4) Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland (5) Division of Intensive Care, Department of Surgery, Helsinki University Hospital, Helsinki, Finland (6) Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland (7) Division of Infectious Diseases, Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland (8) Division of Infectious Diseases, Department of Internal Medicine, Satakunta Central Hospital, Satakunta, Finland Article History: Registration Date: 04/12/2006 Received Date: 29/06/2006 Accepted Date: 01/12/2006 Online Date: 16/01/2007 Article note: For the Finnsepsis Study Group. This research was supported by a grant from the Paivikki and Sakari Sohlberg Foundation ( www.pss-saatio.fi), EVO grant TYH 6235 from Helsinki University Hospital, a grant from the Finnish Intensive Care Association ( www.sthy.fi), and a grant from the Finnish Medical Association ( www.laakariliitto.fi).

Abstract Objective: To assess longterm survival and health-related quality of life in patients with acute renal failure. Design and setting: Cross-sectional cohort study in the ten-bed medical-surgical intensive care unit [...]

Abstract Objective: To assess the value of the diagnosis of overt disseminated intravascular coagulation (DIC) according to the International Society on Thrombosis and Haemostasis (ISTH) criteria and that of the [...]

Abstract Objective: To assess the impact of hemodynamic variables on the outcome of critically ill patients in septic shock and to identify the optimal threshold values related to outcome with [...]

Byline: Anne Kaarlola (1), Ville Pettila (1), Pertti Kekki (2) Keywords: Outcome; Quality of life; EQ-5D; RAND-36; ICU; Adults Abstract: Objective To compare two health-related quality of life measures, the preference-based EQ-5D with five questions and the profile-based RAND-36 with 36 questions, in previous critically ill patients. Design Prospective observational study. Setting A ten-bed medical-surgical intensive care unit (ICU) in a tertiary care university hospital. Patients Of the 2,709 critically ill patients, treated during the years 1995--2000, the 1,099 patients of the 1,443 still alive who returned both mailed measures were included in the study. Interventions None. Measurements and main results The EQ-5D and the RAND-36 correlated well (P Conclusions The EQ-5D and the RAND-36 correlated well, but when more precisely stated information is needed, especially regarding mobility, self-care, or low quality of life levels of previous critically ill patients, the profile-based RAND-36 may discriminate better. Author Affiliation: (1) Department of Anaesthesiology and Intensive Care Medicine, Meilahti Hospital, Helsinki University Central Hospital, P.O. Box 340, 00029, Finland (2) Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland Article History: Registration Date: 24/09/2004 Received Date: 24/02/2004 Accepted Date: 15/09/2004 Online Date: 03/11/2004 Article note: Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-004-2471-6

Byline: Anne Kaarlola (1), Ville Pettila (1), Pertti Kekki (2) Keywords: Long-term quality of life; Outcome; Generic RAND 36; Intensive care; Adults Abstract: Objective To assess the degree of change in long-term quality of life (QOL) in critically ill patients 1 and 6 years after discharge from the intensive care unit (ICU). Design Prospective observational study. Setting A ten-bed medical-surgical ICU in a tertiary care hospital. Patients Of the 591 consecutive patients admitted in 1995 the study comprised those 169 who responded to both QOL questionnaires, sent in 1996 and 2001. Interventions None. Measurements and main results A generic scale assessing health-related QOL, the RAND 36, sent by mail. Six years after discharge 9% of the patients considered their present health status as excellent, 37% as good, 45% as satisfactory and 9% as poor. The absolute values of the different QOL domains revealed worse physical functioning (p Conclusions When evaluating the long-term outcome of ICU patients, the timing of QOL assessment is essential especially the emotional domains seem to improve slowly. Further studies focusing on the effect of time on various QOL domains and the predictive factors for a long-term QOL are therefore warranted. Author Affiliation: (1) Department of Anaesthesia and Intensive Care Medicine, Meilahti Hospital, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland (2) Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 41, 00014, Finland Article History: Received Date: 30/11/2002 Accepted Date: 15/05/2003 Online Date: 15/07/2003

The drug tifacogin may not benefit patients with sepsis and a high international normalized ratio (INR) value, according to a study of 1,754 patients treated at 245 hospitals in 17 countries in North America, Europe, and Israel. Sepsis is a serious bacterial infection in the blood that can cause multiple organ failure. Tifacogin inhibits a substance that causes blood to clot because abnormal blood clotting is believed to occur during sepsis.

Byline: Kimmo I. Halonen (1), Ville Pettila (2), Ari K. Leppaniemi (1), Esko A. Kemppainen (1), Pauli A. Puolakkainen (1), Reijo K. Haapiainen (1) Keywords: Severeacute pancreatitis Quality of life Outcome Abstract: Objective. To evaluate the health-related quality of life (HRQL) and postdischarge outcome after severe acute pancreatitis. Design and setting. Observational study in a department of surgery (surgical and general intensive care unit) in a tertiary care hospital. Patients and participants. Of 283 patients with severe acute pancreatitis 211 survived during a follow-up period an additional 27 died. The Rand 36-item Health Survey with accessory question was mailed to 174 eligible patients. The final study population comprised 145 patients (83% response rate). Age- and sex-matched Finnish population scores were compared with the study population accessory questions were analyzed separately. Results. No clinically significant differences were found in long-term HRQL between study patients and the general population. Of the 145 patients 87% returned to work, 27% suffered recurrent pancreatitis, and 43% developed diabetes. Of 113 patients with alcohol-induced severe acute pancreatitis 30% were abstinent and 28% problem drinkers, alcohol-dependent, or alcoholics. Conclusions. Up to 13% of severe acute pancreatitis patients surviving initial hospitalization die within a few years. Among the survivors long-term HRQL is comparable to that of the normal population. The majority return to work and reduce their alcohol consumption markedly. Author Affiliation: (1) Department of Gastroenterological and General Surgery, Meilahti Hospital, Helsinki University Central Hospital, P.O. Box 340, 00029, Helsinki, Finland (2) Department of Anesthesia and Intensive Care Medicine, Meilahti Hospital, Helsinki University Central Hospital, P.O. Box 340, 00029, Helsinki, Finland Article History: Received Date: 16/12/2002 Accepted Date: 31/01/2003 Article note: Electronic Publication

Byline: Ville Pettila (1), Marja Hynninen (1), Olli Takkunen (1), Pentti Kuusela (2), Matti Valtonen (3) Keywords: Prediction Outcome Cytokines Intensive care Sepsis Procalcitonin Abstract: Abstract Objective. To evaluate the performance of procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein, leukocyte count, D-dimer, and antithrombin III at onset of septic episode and 24 h later in prediction of hospital mortality in critically ill patients with suspected sepsis. Design and setting. Prospective, cohort study in two university hospital intensive care units. Patients. 61 critically ill patients with suspected sepsis. Measurements and results. The outcome measure was hospital mortality. Hospital survivors (n=41) and nonsurvivors (n=20) differed statistically significantly on day 1 (admission) in PCT, IL-6, SOFA score, and APACHE II score, and 24 h later in PCT, IL-6, and D-dimer values. AT III, CRP, and leukocyte count did not differ. The areas under receiver operating curves showed reasonable discriminative power (>0.75) in predicting hospital mortality only for day 2 IL-6 (0.799) and day 2 PCT (0.777) values which were comparable to that of APACHE II (0.786), and which remained the only independent predictor of mortality. Conclusions. Admission and day 2 IL-6, and day 2 PCT, and day 2 D-dimer values differed significantly between hospital survivors and nonsurvivors among critically ill patients with suspected sepsis. However, in prediction of hospital mortality, only the discriminative power of day 2 PCT and IL-6 values, and APACHE II was reasonable as judged by AUC analysis (>0.75). Author Affiliation: (1) Intensive Care Unit, Department of Surgery, Division of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, P.O. Box 340, 00029/HUS, Helsinki, Finland (2) Department of Diagnostics, Helsinki University Hospital, P.O. Box 340, 00029/HUS, Helsinki, Finland (3) Division of Infectious Diseases, Department of Internal Medicine, Helsinki University Hospital, P.O. Box 340, 00029/HUS, Helsinki, Finland Article History: Received Date: 28/11/2001 Accepted Date: 12/06/2002 Article note: Electronic Publication

Byline: Ville Pettila (1), Anne Kaarlola (1), Annikki Makelainen (1) Keywords: Quality of life Outcome Multiple organ dysfunction Generic RAND 36 Intensive care Abstract: Objective: To assess the quality of life (QOL) of intensive care survivors 1 year after discharge with special emphasis on multiple organ dysfunction (MOD). Design: Prospective, observational study. Setting: A ten-bed medical-surgical intensive care unit in a tertiary care hospital. Patients: Among the 591 consecutive patients admitted in the year 1995, 307 of 378 patients who survived 1 year were studied. Interventions: None. Measurements and results: A generic scale assessing health-related QOL, the RAND 36-item Health Survey (RAND 36) was sent by mail 12 months after discharge. Data concerning age, severity of illness, organ dysfunctions and diagnoses were recorded. Of 307 patients, 98 (31.9%) were able to work. The QOL measured by the RAND 36 showed clinically relevant impairment in emotional and physical role limitations compared with an age- and sex-matched general population. MOD (n=131, 42.7%) had a statistically significant negative effect on all QOL domains, except bodily pain and mental health, with the only clinically relevant impairment being in vitality and emotional role limitations compared with non-MOD patients. Of the 131 MOD patients, 36 (27.4%) were able to work, 26 (19.8%) had severe limitations in their daily activities and 5 (3.8%) were unable to live at home 1 year after discharge. Conclusions: One year after intensive care the survivors had a lower QOL than an age-matched general population with clinically relevant further impairment of MOD patients in vitality and emotional role limitations. Author Affiliation: (1) Intensive Care Unit, Division of Anesthesiology, Department of Surgery, Helsinki University Central Hospital, 00290 Helsinki, Finland (2) Address for correspondence: MD, Turuntienportti 3 B 4, 02750 Espoo, Finland Article History: Received Date: 22/10/1999 Accepted Date: 06/07/2000 Article note: Final revision received: 25 April 2000 Electronic Publication

Abstract Background Hospital mortality in patients with severe acute pancreatitis (SAP) remains high. Some of these patients develop increased intra-abdominal pressure (IAP) which may contribute to organ dysfunction. The aims of this study were to evaluate the frequency of increased IAP in patients with SAP and to assess the development of organ dysfunction and factors associated with high IAP. Methods During 2001–2003 a total of 59 patients with severe acute pancreatitis were treated in the intensive care unit (ICU) of Helsinki University Hospital. IAP was measured by the intravesical route in 37 patients with SAP. Data from these patients were retrospectively reviewed. Results Maximal IAP, APACHE II score, maximal SOFA score, maximal creatinine, age and maximal lactate were significantly higher in nonsurvivors. There was a significant correlation of the maximal IAP with the maximal SOFA, APACHE II, maximal creatinine, maximal lactate, base deficit and ICU length of stay. Patients were divided into quartiles according to the maximal IAP. Maximal IAP was 7–14, 15–18, 19–24 and 25–33 mmHg and the hospital mortality rate 10%, 12.5%, 22.2% and 50% in groups 1–4, respectively. A statistically significant difference was seen in the maximal SOFA, ICU length of stay, maximal creatinine and lactate values. The mean ICU-free days in groups 1–4 were 45.7, 38.8, 32.0 and 27.5 days, respectively. The difference between groups 1 and 4 was statistically significant. Conclusion In patients with SAP, increased IAP is associated with development of early organ failure reflected in increased mortality and fewer ICU-free days. Frequent measurement of IAP during intensive care is important in optimizing abdominal perfusion pressure and recognizing patients potentially benefitting from decompressive laparotomy.