Respiratory insufficiency in acute pancreatitis

BACKGROUND: Acute respiratory failure (ARF) is one of the systemic complications of acute pancreatitis (AP). The severity of AP may be objectified by the Ranson index and the radiologic alterations showed by abdominal computerized tomography (CT). The aim of the present was to study the relation between both problems. METHODS: Two hundred ninety-five cases of AP attended between November 1983 and August 1987 were revised. Ranson criteria were used to qualify the 295 AP and the abdominal CT in 85 cases. ARF was defined as PaO2 less than 60 mmHg breathing air at room temperature. The severity of ARF was classified by the respiratory index (RI: PaO2/FIO2) with ARF being considered as severe when less than 200. In 100 cases of AP the thoracic radiologic alterations were objectified and evaluated in order to know their relation with ARF. RESULTS: ARF was the most frequent complication (28%) of AP, being severe in 8%. Pleural effusion was the radiologic alteration most frequently observed (23 patients). In 28% there was no correlation between the radiology and the presence of ARF. The correction of ARF was achieved in 85% of the patients with a mask of O2 less than 40%. Mean ARF was 227. A correlation was found between ARF and the severity of the episode of AP and the changes observed in the abdominal CT. CONCLUSIONS: Acute respiratory failure is the most frequent complication of acute pancreatitis and correlates with the severity of the episode of the latter; classification of the episode of acute respiratory failure by respiratory index is of use.