Hemodynamic Rata Pattern in Patients With Acute Pancreatitis

In 16 patients with necrotizing pancreatitis and in 6 patients with edematous-interstitial pancreatitis, hemodynamic studies were conducted between the first and the 12th day after the onset of illness. Patients with necrotizing pancreatitis had a high cardiac index of 4.47 ? 0.75 Llmin . m2 and a low total peripheral vascular resistance of 884 ? 180 dyn . s/cm5, a low mean pulmonary vascular resistance of 84.3 + 25.7 dyn . s/cm5, and a high pulmonary shunt fraction of 24.2% + 6.6% of the cardiac output. This hyperdynamic vascular pattern was not found in patients with edematous-interstitial pancreatitis associated with gallstone disease. The group ofpatients with edematous-interstitial pancreatitis had a cardiac index of 3.21 + 0.8 Urnin . m’, a total peripheral vascular resistance of 1337.8 k 248.2 dyn . s/cm5, a mean pulmonary vascular resistance of 130.7 + 48.2 dyn . s/cm5, and a pulmonary shunt fraction of 23.6% k 3.5% of the cardiac output. There was a significant difference between the patients with necrotizing pancreatitis and those with edematous-interstitial pancreatitis in the following hemodynamic parameters: heart rate [p < 0.02), cardiac index [p < o.o~), total peripheral vascular resistance (p < 0.001), arteriovenous oxygen difference (p < 0.02), and pulmonary shunt fraction [p < 0.01). These findings in patients with necrotizing pancreatitis demonstrate an opening of intrapuimonary shunts and peripheral vasodilatation probably due to the release of pancreatitis