Lungs lurch adds to pancreas panic

MUMBAI: Going by international mortality figures, BJP leader Pramod Mahajan has a 50 per cent chance of surviving the acute respiratory distress syndrome (ARDS) caused by a lung injury, according to doctors. They say the syndrome, which causes difficulty in breathing, often affects patients with malaria or pneumonia. In Mahajan’s case, the cause could be any: infection, pancreatitis, aspiration (fluid entering the lungs) large blood transfusions, or trauma.

 

In this condition, alveolis, the breathing units in the lungs, are inflamed because of which the capillaries keep leaking fluid into the lungs. “In ARDS, the alveolar-capillary membrane, which connects the air sacks of the lungs with small blood vessels, is damaged,” points out Dr Praful Desai, a consultant chest expert at Lilavati Hospital. “This leads to congestion and reduced oxygenation.”

 

“Modern ventilation strategies have improved the survival rates to 30-50% now,” says consultant chest physician Dr Sujeet Rajan from Bombay Hospital. “As Mahajan is already on a Positive Pressure Ventilator, he would have to be additionally put into the Positive End Expiratory Pressure (PEEP) mode on the ventilator to increase the pressure for exhalation.” The frothy leaking fluid can be sucked out of Mahajan’s body through a catheter in the tube that has been inserted into his windpipe through tracheostomy.

 

Doctors say ARDS usually persists till the inciting factor is addressed. Though it is yet unclear what sparked ARDS in Mahajan’s case, there is cause for anxiety if the lung injury is linked to the pancreas. “The pancreatic surgery would be a major surgery which cannot be undertaken until his blood pressure stabilises. It is therefore a vicious cycle,” said a doctor. Low levels of oxygen can cause damage to other vital organs as well.

 

Mahajan’s pancreas have been a major source of concern for the team of doctors attending on him. The surgical intervention carried out on Mahajan on Saturday was primarily to track any abscess or fluid retention caused by his ruptured pancreas.

 

The pancreas consists of four parts: head, neck, body and tail. “An injury to the head of the pancreas is more devastating than that to other areas,” says Dr Nilesh Doctor, a pancreatic expert. Unfortunately, in Mahajan’s case, the head of the pancreas has been damaged. His being a diabetic makes matters worse.

 

Complicating the problem is an injury to the duodenum as well. As a result, the pancreatic juice and the bile juice secreted by the liver are leaking out into the body instead of being directed into the duodenum. “These juices, meant to aid digestion, are very toxic when they leak,” explains Dr Doctor. However, as it was important to first stop the massive blood loss and stabilise Mahajan, a pancreatic surgery has had to be deferred.  “Even though untreated injury complicates the issue five-time over, it’s better to wait till his vital parameters are stable. You can’t do major surgery on a person whose three organs are dysfunctional,” adds Dr Doctor. “Right now, non-operative treatment is the best. So long as the pancreatic fistula is controlled by draining out the fluid, the risk can be curtailed.”

 

He said Mahajan could recover from his pancreatic malaise, if everything else works fine, and may not even require any medicine.

 

 

Acute Respiratory Distress Syndrome (ARDS) is a medical condition which prevents the normal breathing process from taking place. 

 

ARDS occurs when there is severe inflammation in both lungs resulting in an inability of the lungs to function properly. 

 

It is a devastating, often fatal, inflammatory lung condition that usually occurs in conjunction with catastrophic medical conditions, such as pneumonia, shock, trauma. 

 

 

Former BJP president LK Advani and Chief Minister Vilasrao Deshmukh visited BJP leader Pramod Mahajan at the Hinduja Hospital on Monday. This was their second visit to the hospital.