013) as patients’ clinical conditions improved over time. Over the same time course, IL-6 and TNF concentrations in serum remained statistically unchanged (P = 0.07 and P = 0.309) but in peritoneal lavage fluid Staurosporine datasheet decreased significantly (P = 0.019 and 0.008), whereas hemofiltrate TNF concentrations alone increased (P = 0.03) (Figure 1, panel E). Student’s t-test for matched pairs disclosed a significant association between decreasing cytokine concentrations in serum and peritoneal lavage fluid and decreasing Apache II scores (Figure 1, panel A-E). The only CVVDH-related adverse reaction was a high fever caused by an infected catheter that resolved when the

catheter was removed. Hypophosphatemia developed in two patients and was normalized by BIBW2992 increasing the phosphate content in the CVVDH dialitic solution. Discussion

Our promising results in this single-center preliminary study in selected severely ill patients refractory to ICU therapy suggest that the new approach we propose, emergency laparotomy to resolve abdominal compartment syndrome or sepsis followed by continuous perioperative peritoneal lavage and postoperative CVVDH, successfully reduces local and systemic cytokines thus reducing morbidity and mortality and improving patients’ clinical outcome without increasing the high surgery-related morbidity. All six patients with SAP in this series had high APACHE II scores before surgery, see more indicating MODS [33] and they also had severe SAP-related complications, in five patients an abdominal compartment syndrome and in one sepsis, all refractory to ICU therapy and Mannose-binding protein-associated serine protease therefore

necessitating emergency surgery. In patients with SAP, the inflammatory response (SIRS) to extensive peripancreatic and retroperitoneal fatty tissue damage, may lead to sepsis, acute respiratory distress syndrome (ARDS), acute renal failure, hypovolemic shock, acute liver failure and MODS, now the primary cause of morbidity and mortality in SAP [13]. In accordance with their severe clinical presentation, MODS and multiorgan failure, all our patients with SAP had high perioperative IL-6 and TNF concentrations in serum, peritoneal lavage outflow and CVVDH hemofiltrate, presumably related to pro-inflammatory cytokine release and neutrophil activation [22, 23]. Although we measured only IL-6 and TNF, other inflammatory mediators known to play a critical role in acute pancreatitis and MODS include TNFa, IL-1b, IL-6, IL-8, platelet-activating factor, and IL-10 [3, 22–28]. Our study extends to the few therapeutic options for removing the inflammatory mediators responsible for SAP-related systemic complications [33]. In all 6 patients we treated, anti-inflammatory therapy using continuous perioperative peritoneal lavage and postoperative CVVDH effectively reduced IL-6 and TNF concentrations in peritoneal lavage fluid and serum.