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How to deal with severe acute pancreatitis in the critically ill

De Waele, Elisabetha,b; Malbrain, Manu L.N.G.a,c; Spapen, Herbert D.a,c

Current Opinion in Critical Care: April 2019 - Volume 25 - Issue 2 - p 150–156
doi: 10.1097/MCC.0000000000000596
GASTROINTESTINAL SYSTEM: Edited by Constantine J. Karvellas
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Purpose of review To review recent literature on the management of patients with severe acute pancreatitis (SAP) admitted to an ICU.

Recent findings SAP is a devastating disease associated with a high morbidity and mortality. Recent evidence advocates adequate risk assessment and severity prediction (including intra-abdominal pressure monitoring), tailored fluid administration favoring balanced crystalloids, withholding prophylactic antibiotic therapy, and early detection and treatment of extra-pancreatic and fungal infections. Urgent (within 24–48 h after diagnosis) endoscopic retrograde cholangiopancreatography is indicated when persistent biliary obstruction or cholangitis are present. Corticosteroid therapy (mainly dexamethasone) can reduce the need for surgical interventions, length of hospital stay, and mortality. Peritoneal lavage may significantly lower morbidity and mortality. Hemofiltration may offer substantial benefit but more studies are needed to prove its efficacy. Enteral feeding using a polymeric formula and provided early through a nasogastric tube is recommended but has no survival benefit compared with parenteral nutrition. Probiotics could be beneficial, however no clear recommendations can be made.

Summary Management of SAP is multimodal with emphasis on monitoring, adequate fluid resuscitation, avoiding prophylactic use of antibiotics, cause-directed procedures or treatment, and organ support. There is a role for early enteral nutrition including probiotics.

aDepartment of Intensive Care Medicine, Universitair Ziekenhuis Brussel, Jette

bClinical Nutrition Unit, Universitair Ziekenhuis Brussel

cFaculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Jette, Belgium

Correspondence to Elisabeth De Waele, MD, PhD, ICU Department, UZ Brussel, 101, Laarbeeklaan, 1090 Jette, Belgium. Tel: +32 2 477 51 78; fax: +32 2 477 52 53; e-mail: elisabeth.dewaele@uzbrussel.be

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