Pancréatites aiguës en réanimation : quoi de neuf ?

Acute severe pancreatitis are more frequent in men older than 50 years. Alcoholic and biliary pancreatitis are the two main causes. Acute pancreatitis is related to the destruction of the pancreatic tissue by enzymes normally evacuated in the digestive tract. The initial inflammatory phase is responsible for multiple organ failure and shock. The diagnosis is performed in patients with acute abdominal pain syndrome and more than three times elevated lipase plasma concentration. CT scan is useful when the diagnosis is only suspected. Severity is evaluated on clinical (Ranson, BISAP) and radiological (Balthazar) scores. Hypovolemia is the main haemodynamic feature. Pleural effusion, atelectasis and abdominal distension significantly worsen respiratory condition. Pain treatment is mandatory. Enteral nutritional support is not contraindicated. Early surgical procedure may be indicated such as sphincterotomy for biliary tract obstruction and laparostomy in case of abdominal compartment syndrome. Necrotizing effusions need to be drained or evacuated by minimally invasive surgical procedures if infected. Antibioprophylaxis is not indicated.