Intensive care treatment with recombinant human thrombomodulin administration in a patient with severe acute pancreatitis and disseminated intravascular coagulation

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.

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Prolonged intensive care treatment of octogenarians after cardiac surgery: Is the economic burden justified?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297792 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

H Deschka ◽

L Vöhringer ◽

J Neufeld ◽

G Wimmer-Greinecker

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Economic Burden ◽

Intensive Care Treatment ◽

Care Treatment

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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

Zeitschrift für Gastroenterologie ◽

10.1055/a-1401-2387 ◽

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.

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

Burns ◽

10.1016/j.burns.2019.02.005 ◽

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

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THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600010002 ◽

2016 ◽

Vol 29 (1) ◽

pp. 5-8 ◽

Cited By ~ 1

Author(s):

Murilo Gamba BEDUSCHI ◽

André Luiz Parizi MELLO ◽

Bruno VON-MÜHLEN ◽

Orli FRANZON

Keyword(s):

Acute Pancreatitis ◽

Intensive Care ◽

Length Of Stay ◽

Severe Acute Pancreatitis ◽

Predictive Value ◽

High Specificity ◽

Daily Practice ◽

Severe Form ◽

Inclusion Criteria ◽

Positive Score

Background: About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. Objective: To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Methods: Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Results: Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. Conclusion: The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.

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