The management of severe acute necrotising pancreatitis: an evidence-based review of the literature.

Abstract:

:Clearly the main determinant of outcome in severe acute pancreatitis is the extent of pancreatic necrosis and the subsequent risk for the development of infected necrosis. A thorough assessment using appropriate scoring systems and the early use of dynamic contrast-enhanced CT will highlight those patients likely to benefit from higher dependency or intensive care. Despite numerous suggested specific therapies there is still no Grade A evidence that any confers a significant mortality benefit. However, general supportive measures should include vigorous replacement of fluid losses to correct the circulating volume, correction of electrolyte and glucose abnormalities, and respiratory, cardiovascular and renal support as necessary. Those patients with infected pancreatic necrosis or deteriorating organ systems should undergo surgery. Patients with sterile necrosis should receive a broad-spectrum prophylactic antibiotic which adequately penetrates pancreatic tissue. Due attention should also be paid to nutritional support, for which a jejunal feeding tube with EN is recommended as early as is achievable.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Wyncoll DL

doi

10.1007/s001340050808

keywords:

subject

Has Abstract

pub_date

1999-02-01 00:00:00

pages

146-56

issue

2

eissn

0342-4642

issn

1432-1238

journal_volume

25

pub_type

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