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Abstract

430CT = computed tomography; FNAB = fine needle aspiration biopsy; SAP = severe acute pancreatitis. Critical Care December 2004 Vol 8 No 6 Gerlach IntroductionSevere acute pancreatitis (SAP) can progress to a critical condition within a few hours or days after the onset of symptoms. Particularly during the early course of the disease, patients are at high risk for developing infections with subsequent multiple organ dysfunction syndrome. Therefore, early surgical intervention has been favoured, although evidence-based data are lacking. In this issue of Critical Care, De Waele and coworkers [1] present findings from a critical review conducted over nearly a decade. In contrast to many prior recommendations, the authors could not find any significant association between the timing of surgery and patient outcomes. Moreover, they identified patient age, severity of organ dysfunction at the time of surgery, and the presence of sterile necrosis as the main risk factors, and concluded that an early surgical intervention is not justified in the absence of proven infection when necrosis is detected after computed tomography (CT) scan [1]. These important findings once again raise the issue of risk assessment in the individual patient with SAP. Current practiceA major problem in the treatment of patients with SAP is the lack of randomized trials. Recently, King and coworkers [2] reported results from the first pan-European survey conducted among specialists in hepato-pancreato-biliary surgery of surgical strategies for management of SAP, with the aim being to highlight areas of discordance and thus provide a rational focus for future research. A questionnaire survey of 866 surgeons was undertaken, and the response rate was 38%. Severity stratification was used by 324 respondents (99%), with the Ranson score being the most popular. Antibiotic prophylaxis was utilized by 73%, and fine needle aspiration biopsy (FNAB) was undertaken by 53% of respondents. Furthermore, the results show that there were further aspects of practice that were concordant among AbstractPrimary or secondary infection of necrotized areas by enteral bacteria is considered a primary cause of mortality in patients with severe acute pancreatitis (SAP). Indeed, 20-30% of patients die during the course of the disease from multiple organ dysfunction after infection. This is why strategies such as antibiotic prophylaxis and early surgical intervention are appealing, but the controlled data that support these measures are insufficient. On the other hand, environmental risk factors (e.g. smoking, alcohol) and genetic predisposition have been identified; together, these led to SAP being considered a 'multifactorial' disease. However, this description does not help the intensivist to assess risk in the individual patient. A number of prognostic factors in SAP have been identified, and different scoring systems have been developed that include therapy-associated and patient-related factors. Nevertheless, at present no prognostic model is available that takes into...

Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta-analysis

“…As shown in Table 3 , there was no significant difference between the NG and NJ feeding groups at admission with respect to MOF and IPN. Because primary or secondary infection of necrotized areas by enteral bacteria is considered a primary cause of mortality in patients with SAP, which is characterized by rapidly progressive MOF [ 26 ], we can conclude that the severity of the disease in the NG and NJ feeding groups was equivalent at admission, validating the comparison of NG and NJ feeding. APACHE II scores can provide better prediction of mortality in patients with SAP [ 27 ].…”