ICU SAQs · GI & nutrition / surgical
Severe acute pancreatitis — severity, fluids, and infected necrosis
A CICM SAQ on severe acute pancreatitis — revised Atlanta (persistent organ failure over 48 h), WATERFALL moderate fluids, ACG 2013 enteral nutrition in severe disease, no prophylactic antibiotics, ERCP for concurrent cholangitis, and the infected-necrosis step-up.
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Prompt
A 50-year-old presents with the severe epigastric pain, the lipase 1500, and the gallstones on the ultrasound. At the 48 hours, the patient has the persistent SIRS, the oliguria, and the hypoxia. Discuss the severity assessment and the ICU management.
Question
A 50-year-old presents with the severe epigastric pain, the lipase 1500, and the gallstones on the ultrasound. At the 48 hours, the patient has the persistent SIRS, the oliguria, and the hypoxia. Discuss the severity assessment and the ICU management.
[1]References7ShowHide
- [1]Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus Gut, 2013.PMID 23100216
- [2]de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis N Engl J Med, 2022.PMID 36103415
- [3]Tenner S, Baillie J, DeWitt J, Vege SS American College of Gastroenterology guideline: management of acute pancreatitis Am J Gastroenterol, 2013.PMID 23896955
- [4]van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis N Engl J Med, 2010.PMID 20410514
- [5]Poropat G, Goričanec K, Lacković A, et al. Systematic Review with Trial Sequential Analysis of Prophylactic Antibiotics for Acute Pancreatitis Antibiotics (Basel), 2022.PMID 36139970
- [6]Boxhoorn L, van Dijk SM, van Grinsven J, et al. Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis N Engl J Med, 2021.PMID 34614330
- [7]Tenner S, Vege SS, Sheth SG, et al. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis Am J Gastroenterol, 2024.PMID 38857482