Acute pancreatitis: an intensive care perspective

Acute pancreatitis (AP) is a sudden inflammation of the pancreas, which is often mild and resolves spontaneously. However, if severe it can cause significant morbidity and mortality and commonly requires management in the intensive care unit. The diagnosis of AP involves a combination of clinical symptoms, elevations in pancreatic enzymes and/or characteristic findings on computer tomography. In 2012, the Atlanta Symposium revised the classification of pancreatitis into mild, moderate and severe. The key to appropriate management is identifying patients with severe AP, and initiating intensive care supports at an early stage. Scoring systems such as the Ranson/Imrie score, and the Acute Physiology and Chronic Health Evaluation II score are used to help determine severity. The general management involves physiological support, with fluid resuscitation, enteral feeding and support of the vital organs. The use of prophylactic antibiotics is currently not supported. Pancreatic collections should be drained by interventional radiology and sent for culture and antimicrobial sensitivity assessment. This review article outlines the assessment and management principles of severe pancreatitis in the intensive care setting.