scholarly journals Operative vs Non-Operative Management in Sterile Necrotizing Pancreatitis

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 188-191 ◽  
Author(s):  
Edward L. Bradley
Keyword(s):  
Intensive Care ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Operative Management ◽  
Needle Aspiration ◽  
Apache Ii ◽  
Intensive Care Treatment ◽  
Intensive Care Therapy ◽  
Care Treatment ◽  
Organ Complications

Background: The clinical management of sterile pancreatic necrosis is still a matter of debate. In this study we analyzed the clinical course and outcome of patients with sterile necrotizing pancreatitis treated surgically versus nonsurgically.Study Design: Between May 1982 and December 1993, 249 patients with necrotizing pancreatitis (NP) entered this study, of which 172 (69 percent) had intraoperatively or fine needle aspiration-proven sterile NP. One hundred seven of 172 patients underwent surgery (S group) with necrosectomy and continuous postoperative closed lavage and 65 of 172 were treated by nonsurgical means (NS group).Results: Median Ranson and admission APACHE II scores were 4.7 (range, 1 to 10) and 11 (range, 1 to 29) in the S group, significantly higher than those in the NS group with 3.0 (range, 0 to 6) (p=0.022) and 8 (range, 1 to 23) (p=0.036). After 48 hours of intensive care treatment, APACHE II scores persisted at 10.5 (range, 1 to 29) in the S group and decreased to 6 (range, 0 to 15) (p=0.013) in the NS patients. Median Creactive protein (CRP) levels on admission were 179 mg/L and 68.5 mg/L (p=0.023), respectively. Within 72 hours, 61 (94 percent) of 65 NS-managed patients responded to intensive care therapy, whereas organ complications persisted or increased and thus led to surgery in the S group. Mortality rates were 13.1 percent in the surgically treated patients and 6.2 percent in the nonsurgically treated patients (p=NS).Conclusions: Most patients with limited and sterile pancreatic necrosis respond to intensive care treatment. Indication for surgery in sterile NP should be based on persisting or advancing organ complications despite intensive care therapy. APACHE II scores and adraission CRP levels represent a helpful tool in decision making for surgical or nonsurgical management of NP.

scholarly journals The Role of Surgery in the Management of Acute Pancreatitis

2000 ◽  
Vol 14 (suppl d) ◽  
pp. 136D-140D ◽  
Author(s):  
Beat Gloor ◽  
Waldemar Uhl ◽  
Christophe A Müller ◽  
Markus W Büchler
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Necrotizing Pancreatitis ◽  
Bleeding Risk ◽  
Intensive Care Treatment ◽  
Papilla Of Vater ◽  
Infected Necrosis ◽  
Intensive Care Unit Treatment ◽  
Care Treatment ◽  
Mechanical Factors

The clinical course of an episode of acute pancreatitis varies from a mild, transitory form to a severe necrotizing form characterized by multisystem organ failure and mortality in 20% to 40% of cases. Mild pancreatitis does not need specialized treatment, and surgery is necessary only to treat underlying mechanical factors such as gallstones or tumours at the papilla of Vater. On the other hand, patients with severe necrotizing pancreatitis need to be identified as early as possible after the onset of symptoms to start intensive care treatment. In this subgroup of patients, approximately 15% to 20% of all patients with acute pancreatitis, stratification according to infection status is crucial. Patients with infected necrosis must undergo surgical intervention, which consists of an organpreserving necrosectomy followed by postoperative lavage and/or drainage to evacuate necrotic debris, which appears during the further course of the condition. Primary intensive care treatment, including antibiotic treatment, delays the need for surgery in most patients until the third or fourth week after the onset of symptoms. At that time, necrosectomy is technically easier to perform and the bleeding risk is reduced, compared with necrosectomy earlier in the disease course. In patients with sterile necrosis, the available data strongly support a conservative approach (ie, intensive care unit treatment). Surgery is rarely necessary in these patients.

scholarly journals Infected Pancreatic Necrosis Mimicking Pancreatic Cancer

2020 ◽  
Vol 14 (2) ◽  
pp. 436-442
Author(s):  
Jun Heo
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Needle Aspiration ◽  
Infected Pancreatic Necrosis ◽  
Ultrasound Guided ◽  
Fine Needle

Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with infected pancreatic necrosis may have fever, chills, and abdominal pain as inflammatory symptoms. These specific clinical presentations can differentiate infected pancreatic necrosis from other pancreatic diseases. Herein, I report an atypical case of infected pancreatic necrosis in which abdominal pain, elevation of white blood cell, and fever were not found at the time of admission. Rather, a 10-kg weight loss (from 81 to 71 kg) over 2 months nearly led to a misdiagnosis of pancreatic cancer. The patient was finally diagnosed based on endoscopic ultrasound-guided fine-needle aspiration. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important. In addition, endoscopic ultrasound-guided fine-needle aspiration should be recommended for the diagnosis and treatment of indeterminate pancreatic lesions in selected patients.

The presence of liver cirrhosis is a strong negative predictor of survival for patients admitted to the intensive care unit – Cirrhosis in intensive care patients

2021 ◽  
Author(s):  
Jörg Bojunga ◽  
Mireen Friedrich-Rust ◽  
Alica Kubesch ◽  
Kai Henrik Peiffer ◽  
Hannes Abramowski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Cirrhosis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Treatment ◽  
Matched Cohort ◽  
Care Treatment ◽  
Cirrhotic Patients ◽  
The Impact ◽  
Cirrhotic Group

Abstract Background and Aims Liver cirrhosis is a systemic disease that substantially impacts the body’s physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions. Methods In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS). Results A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group.  Conclusions In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients’ outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.

Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix

Burns ◽  
2019 ◽  
Vol 45 (5) ◽  
pp. 1057-1065
Author(s):  
Rolf K. Gigengack ◽  
Margriet E. van Baar ◽  
Berry I. Cleffken ◽  
Jan Dokter ◽  
Cornelis H. van der Vlies
Keyword(s):  
Intensive Care ◽  
Case Mix ◽  
Intensive Care Treatment ◽  
Care Treatment

Intensive care treatment of patients with IBD

1998 ◽  
Vol 114 ◽  
pp. A999
Author(s):  
W. Huber ◽  
B. Jeschke ◽  
U. Schweigart ◽  
M. Classen
Keyword(s):  
Intensive Care ◽  
Intensive Care Treatment ◽  
Care Treatment

Intensive care treatment of patients with bleeding esophageal varices

1992 ◽  
Vol 20 (11) ◽  
pp. 1555-1563 ◽  
Author(s):  
HUILING LEE ◽  
FELICITY H. HAWKER ◽  
WARWICK SELBY ◽  
DAVID B. MCWILLIAM ◽  
ROBERT G. HERKES
Keyword(s):  
Intensive Care ◽  
Esophageal Varices ◽  
Intensive Care Treatment ◽  
Bleeding Esophageal Varices ◽  
Care Treatment

scholarly journals Pregnant and postpartum women requiring intensive care treatment for COVID-19 – first data from the CRONOS-registry

2021 ◽  
Author(s):  
M Sitter ◽  
U Pecks ◽  
M Rüdiger ◽  
S Friedrich ◽  
S Fill Malfertheiner ◽  
...  
Keyword(s):  
Intensive Care ◽  
Postpartum Women ◽  
Intensive Care Treatment ◽  
Care Treatment
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