• Medicina intensiva · Dec 2019

    Observational Study

    Results of the modification of an acute pancreatitis management protocol in Intensive Care medicine.

    • L Amas Gómez and F Zubia Olaskoaga.
    • Servicio de Medicina Intensiva, Hospital Universitario Donostia, OSI Donostialdea, San Sebastián, Guipúzcoa, España. Electronic address: leyre_amas@hotmail.com.
    • Med Intensiva. 2019 Dec 1; 43 (9): 546-555.

    ObjectiveTo determine whether the implementation of a protocol for the management of patients with acute pancreatitis (AP) in an Intensive Care Unit (ICU) improves the clinical outcomes.DesignA retrospective, before-after observational case series study was carried out.Study Period1 January 2001 to 31 December 2016, divided in 2 periods (pre-protocol 2001-2007, post-protocol 2008-2016).ScopeAn ICU with 48 beds and a recruitment population of 700,000 inhabitants.ParticipantsAP patients admitted to the ICU, with no exclusion criteria.InterventionsThe recommendations proposed in the 7th Consensus Conference of the SEMICYUC on AP (5 September 2007) were applied in the second period.Main Variables Of InterestPatient age, sex, APACHE II, SOFA, study period, pre-ICU hospital stay, nutrition, surgery, antibiotic prophylaxis, hospital mortality, ICU length of stay, hospital length of stay, determinant-based classification.ResultsThe study comprised 286 patients (94 in the pre-protocol period, 192 in the post-protocol period), with a global in-hospital mortality rate of 23.1% (n=66). Application of the protocol decreased the pre-ICU hospital stay and the use of antibiotic prophylaxis, and increased the use of enteral nutrition. Hospital mortality decreased in the second period (35.1 vs. 17.18%; P=.001), with no significant changes in ICU and hospital stays. In the multivariate logistic regression analysis, the variable period of treatment remained as a variable of statistical significance in terms of hospital mortality (OR 0.34 for the period 2008-2016, 95% CI 0.15-0.74).ConclusionsThe implementation of a protocol could result in decreased mortality among AP patients admitted to the ICU.Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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