Management of acute pancreatitis in the intensive care unit

Acute pancreatitis is a disease with a variety of symptoms. In patients in whom the disease takes a more severe course, stabilization is mandatory, often in a high dependency unit or intensive care unit. When the pancreatitis is of biliary origin and cholangitis and cholestatic changes are proven or suspected, an endoscopic cholangiopancreaticography is indicated. Aggressive organ support and continuation of the prophylactic antibiotics are the mainstay of treatment. When infected necrosis has been proven by CT-guided fine needle biopsy, surgical necrotectomy and debridement with drainage are necessary. Enteral feeding is superior to parenteral feeding even in situations of severe pancreatitis. Further investigation into the role of selective digestive tract decontamination, by controlled randomized trials, is needed.