Exocrine pancreatic function in critically ill patients: Septic shock versus non-septic patients

Objective: To determine the exocrine pancreatic function in critically ill patients. Design:Prospective cohort study. Setting: Medical intensive care unit. Patients: A total of 18 critically ill patients (11 patients with septic sh ock according to the criteria of the American College of Chest Physicians/S ociety of Critical Care Medicine, 7 nonseptic patients). The results obtain ed in these subjects were compared with the data obtained in seven healthy volunteers. Interventions: Examination of exocrine pancreatic function was done by mean s of a cholecystokinin-secretin test. Intravenous stimulation of the exocri ne pancreas with cholecystokinin and secretin (1 unit/kg body weight/hr eac h) and aspiration of duodenal fluid by a gastroscopically inserted oroduode nal tube was done during a period of 1 hr. Measurements and Main Results: The content of amylase, chymotrypsin, and tr ypsin in aspirated duodenal fluid was significantly reduced in patients wit h septic shock compared with nonseptic patients as well as healthy subjects (p < .01). The volume of aspirated fluid was significantly reduced in pati ents with septic shock compared with healthy controls (p = .03), but not in nonseptic patients. The content of bicarbonate was not statistically diffe rent in the three groups. No significant correlation was to find between va riables of exocrine pancreatic function and Acute Physiology and Chronic He alth Evaluation III score, sepsis-related organ failure assessment score, s ystolic arterial pressure and mean arterial pressure in septic shock patien ts. Positive end-expiratory pressure was significantly correlated with the content of trypsin (r(2) = 0.52; p = .02). Postmortem examinations of five septic patients who died during the intensive care stay did not reveal gros s morphologic alterations of pancreatic tissue. Conclusions: The study shows two pancreatic enzyme systems, namely, amylase as a carbohydrate splitting enzyme and the proteolytic enzymes trypsin and chymotrypsin, strongly affected in critically ill patients with septic sho ck.