Admission, management and outcomes of acute pancreatitis in intensive care

BackgroundA review of the management of acute pancreatitis (AP) at a tertiary intensive care unit (ICU) in Auckland, New Zealand, was published in 2004. This paper aims to update this series and identify changes in admission criteria, management and outcomes. MethodsA retrospective review of patients admitted to the Department of Critical Care Medicine, Auckland City Hospital, with AP from 2003 to 2014 was undertaken and data compared with the previous study (1988-2001). ResultsEighty-four patients (male 53, meanSD age=56.9 +/- 15years) with 85 admissions to ICU from 2003 to 2014 were compared with 112 patients in the previous study. Maori were over-represented. Median duration of symptoms prior to admission to ICU decreased from 7 to 3days. The proportion of total AP patients admitted to ICU halved and the mean Acute Physiology and Chronic Health Evaluation II score on admission decreased from mean 19.9 +/- 8.2 SD to 15.4 +/- 7.3 (P<0.001). Two thirds of patients had persistent organ failure. The use of enteral feeding doubled from 46/112 (41%) to 71/85 (84%) (P<0.001). The use of primary percutaneous drainage increased from 14/112 (13%) to 24/85 (28%) (P=0.007). Rate of necrosectomy was similar (36/112 (32%) versus 20/85 (24%), P=0.205), although minimally invasive necrosectomy was introduced. Overall hospital mortality decreased by 29% (P=0.198). ConclusionThere have been changes to the admission criteria and management in line with evolving guidelines and, overall, outcomes have improved.