A modern approach to the intensive treatment of patients with severe acute pancreatitis
DOI:
https://doi.org/10.6016/ZdravVestn.2886Keywords:
severe acute pancreatitis, pancreatic necrosis, infection, inflammation, multiorgan failure, ARDS, protective ventilation, intraabdominal hipertension, parenteral nutrition, enteral nutrition, epidural analgesia, minimal invasive operative proceduresAbstract
Severe acute pancreatitis (SAP) is an acute inflammatory disorder of the pancreas which is associated with significant morbidity and mortality. The main characteristic of the disease is severe systemic inflammation which can be complicated by multiorgan failure and infection of pancreatic necrosis. Repeated assessment of the severity of SAP, based on clinical signs, intensive care monitoring, blood tests and imaging tools should be performed to determine the optimal way of treatment for each patient. Infectious complications in SAP are considerable problem and have an impact on outcome in patients who survived the first inflammatory hit of the disease. The diagnosis of infected pancreatic necrosis is often challenging. At this moment, the only rational indication for antibiotic treatment is documented infection. If the patient’s condition allows, enteral nutrition should be implemented, otherwise pareneteral or combined nutrition is advised. Surgical treatment of SAP is nowadays delayed and includes minimally invasive techniques. The intensive care of SAP patients is oriented towards supportive treatment and prevention of complications.
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