Intensive care management of acute pancreatitis

Abstract

Acute pancreatitis is characterized by an intense inflammatory process which leads to early widespread organ dysfunction and late local complications. Currently, for the 80% of patients who suffer a moderate attack, management is largely supportive. The remaining 20% who develop severe pancreatitis have an increased risk of major complications which may require intensive care management. In these patients both general supportive and some specific therapeutic measures may be necessary. General measures include restoration and maintenance of plasma volume, respiratory, renal and nutritional support, analgesia and antibiotics. Specific measures, such as inhibition of pancreatic secretion or pancreatic enzyme activation, have not been successful in clinical trials. However, most of these studies have included small numbers of patients with moderate pancreatitis. Further evaluation of this approach is required with larger numbers and sicker patients. When bacterial infection of pancreatic necrosis becomes evident, surgical intervention should be considered. This includes percutaneous drainage, endoscopic removal of impacted gallstones and aggressive surgery for necrosis.