Management of the critically ill patient with severe acute pancreatitis

作者：Avery B. Nathens, J. Randall Curtis, Richard J Beale, Deborah J. Cook, Rui Paulo Moreno, Jacques-André Romand, Shawn J. Skerrett, Renee D. Stapleton, Lorraine B. Ware, Carl S. Waldmann · 发表于：Critical Care Medicine · 年份：2004 · DOI：10.1097/01.ccm.0000148222.09869.92 · 被引用次数：361 · 研究领域：Pancreatitis Pathology and Treatment、Sepsis Diagnosis and Treatment、Lymphatic Disorders and Treatments

OBJECTIVE: Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course requiring only brief hospitalization to a rapidly progressive, fulminant illness resulting in the multiple organ dysfunction syndrome (MODS), with or without accompanying sepsis. The goal of this consensus statement is to provide recommendations regarding the management of the critically ill patient with severe acute pancreatitis (SAP). DATA SOURCES AND METHODS: An international consensus conference was held in April 2004 to develop recommendations for the management of the critically ill patient with SAP. Evidence-based recommendations were developed by a jury of ten persons representing surgery, internal medicine, and critical care after conferring with experts and reviewing the pertinent literature to address specific questions concerning the management of patients with severe acute pancreatitis. DATA SYNTHESIS: There were a total of 23 recommendations developed to provide guidance to critical care clinicians caring for the patient with SAP. Topics addressed were as follows. 1) When should the patient admitted with acute pancreatitis be monitored in an ICU or stepdown unit? 2) Should patients with severe acute pancreatitis receive prophylactic antibiotics? 3) What is the optimal mode and timing of nutritional support for the patient with SAP? 4) What are the indications for surgery in acute pancreatitis, what is the optimal timing for intervention, and what are the roles...