%0 Journal Article
%T Abdominal obesity and prolonged prone positioning increase risk of developing sclerosing cholangitis in critically ill patients with influenza A-associated ARDS
%A Thomas Weig
%A Mirjam I Schubert
%A Norbert Gruener
%A Michael E Dolch
%A Lorenz Frey
%A Jens Miller
%A Thorsten Johnson
%A Michael Irlbeck
%J European Journal of Medical Research
%D 2012
%I BioMed Central
%R 10.1186/2047-783x-17-30
%X Twenty-one patients (5 female, 16 male, 46.3 ¡À 10.8 years) with severe ARDS due to H1N1 pneumonia were retrospectively divided into two groups, characterized by the presence (n = 5) and absence of SC-CIP (n = 16). A large array of clinical data, laboratory parameters, and multi-detector computed tomography-derived measures were compared.Both patient groups showed severe pulmonary impairment. Severity of disease on admission day and during the first 14 days of treatment showed no difference. The patients developing SC-CIP had a higher body mass index (BMI) (37.4 ¡À 6.0 kg/m2 vs. 29.3 ¡À 6.8 kg/m2; P = 0.029) and a higher volume of intraperitoneal fat (8273 ¡À 3659 cm3 vs. 5131 ¡À 2268 cm3; P = 0.033) and spent a longer cumulative period in the prone position during the first 14 days (165 ¡À 117 h vs. 78 ¡À 61 h; P = 0.038).Our results suggest that obesity, intraperitoneal fat volume, and a longer cumulative duration spent in the prone position may put patients with ARDS at risk of developing SC-CIP. These results lead us to propose that the prone position should be carefully deployed, particularly in abdominally obese patients, and that frequent checks be made for early hepatic dysfunction.Secondary sclerosing cholangitis in critically ill patients (SC-CIP) has only recently been described as a complication in patients suffering from severe life-threatening illness requiring prolonged intensive care treatment. In the first review of SC-CIP, it was suggested that mechanical ventilation with high positive end-expiratory pressure (PEEP) and low tidal volume in combination with vasoconstrictor therapy might promote arterial hypoperfusion of the peri-biliary vascular plexus, causing ischemic injury to bile duct epithelium, triggering the development of sclerosing cholangitis [1]. Prone positioning of the patient in the ICU might have an additive effect [2]. In reported cases of SC-CIP in literature, the number of liver function tests indicating cholestasis increased during the
%K Intraperitoneal fat
%K Multi-organ dysfunction syndrome
%K Obesity
%K Prone position
%K Sclerosing cholangitis in critically ill patients
%U http://www.eurjmedres.com/content/17/1/30