The management of severe acute pancreatitis – state of the art

Czech version

Authors: F. Vyhnánek ¹; I. Vyhnánková ²
Authors‘ workplace: Chirurgická klinika, Univerzita Karlova, 3. lékařská fakulta, Praha ¹; II. interní klinika, Fakultní Thomayerova nemocnice, Praha ²
Published in: Anest. intenziv. Med., 19, 2008, č. 1, s. 47-53
Category: Intensive Medicine

Overview

Necrotizing pancreatitis develops in about 25% of patients with acute pancreatitis (AP). The severity of AP is linked to the presence of systemic and organ dysfunctions and/or the necrotizing process. Risk factors determining independently the outcome of severe AP are early multi-organ failure, infection of necrotic tissue and extended necrosis. Up to one third of patients with necrotizing pancreatitis develop infection of the necrosis in the later course. Current methods of therapy in severe AP based on EBM treatment guidelines have resulted in decreased operative morbidity, mortality and length of hospital stay in patients with infected pancreatic necrosis. Morbidity of severe AP is biphasic, related to the persistence of organ or multiorgan dysfunction in the early phase and later after the first week due to sepsis caused by infected necrosis leading to the multi-organ failure syndrome. Patients who suffer early organ dysfunction or are at risk of developing a severe disease require intensive care treatment. Early intravenous fluid replacement is of foremost importance for restoring a normal haemodynamic function. Antimicrobial prophylaxis has not been shown to be an effective preventive treatment. Early enteral feeding results in a reduction of local and systemic infection. Conservative treatment with continuous regional arterial application of protease inhibitors and antibiotics is presented as a treatment method with reduced incidence of infection, rate of surgery and mortality in severe AP. Patients suffering an infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for surgical or interventional therapy. Another indication for early surgery is the abdominal compartment syndrome. Precise and repeated revision of the EBM treatment guidelines plays a primary role in optimizing the effectiveness of individual procedures in severe AP and their application is associated with decreased mortality.

Keywords:
severe acute pancreatitis – diagnosis – treatment

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