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Exocrine pancreatic involvement in critically ill patients
Philip D Hardt1, Konstantin Mayer, Nils Ewald
1University Hospital Giessen and Marburg, Giessen Site, Third Medical Department, Giessen, Germany. philip.d.hardt@innere.med.uni-giessen.de
Current Opinion in Clinical Nutrition and Metabolic Care
|February 10, 2009
Summary
Critically ill patients frequently experience pancreatic damage, indicated by elevated pancreatic enzymes. While often without severe consequences, this damage can lead to complications, highlighting the need for risk factor identification and updated treatment strategies.
Area of Science:
- Critical care medicine
- Gastroenterology
- Pancreatology
Background:
- Exocrine pancreatic involvement is common in critically ill patients.
- Elevated pancreatic enzyme levels are seen in up to 80% of intensive care unit (ICU) patients.
- This elevation signifies pancreatic damage, posing a risk for complications.
Purpose of the Study:
- To review the prevalence of exocrine pancreatic dysfunction in critically ill patients.
- To explore the pathophysiology of pancreatic damage in this population.
- To discuss current and emerging treatment strategies for pancreatic involvement in critical illness.
Main Methods:
- Review of existing literature on pancreatic enzyme elevations in ICU patients.
- Analysis of factors contributing to pancreatic damage in critical illness.
- Evaluation of diagnostic tools and therapeutic interventions.
Main Results:
- Pancreatic enzyme elevations are prevalent in up to 80% of ICU patients.
- Most cases do not result in clinically significant pancreatitis.
- Identified contributing factors include hypoperfusion, bacterial translocation, hypertriglyceridemia, and certain medications.
- Imaging and inflammatory markers aid in identifying relevant pancreatic disease.
Conclusions:
- Pancreatic damage is a frequent finding in critically ill patients.
- While often subclinical, it can progress to clinically relevant pancreatitis, increasing morbidity and mortality.
- Risk factors are increasingly understood, and therapeutic approaches, such as early enteral nutrition, are evolving.
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