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Postgraduate Education Corner: CONTEMPORARY REVIEWS IN CRITICAL CARE MEDICINE |

Acute Pancreatitis and Critical Illness: A Pancreatic Tale of Hypoperfusion and Inflammation

Sarah E. Greer, MD, MPH; Kenneth W. Burchard, MD
Author and Funding Information

Affiliations: From the Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Correspondence to: Kenneth W. Burchard, MD, Dartmouth-Hitchcock Medical Center, Department of General Surgery, One Medical Center Dr, Lebanon, NH 03756; e-mail: Kenneth.W.Burchard@Hitchcock.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(5):1413-1419. doi:10.1378/chest.08-2616
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Since it was first widely recognized at the end of the 19th century, acute pancreatitis has proven a formidable clinical challenge, frequently resulting in management within critical care settings. Because the early assessment of severity is difficult, the recognition of severe acute pancreatitis (SAP) and the implementation of critical care treatment precepts often are delayed. Although different management strategies for life-threatening features of SAP have been debated for decades, there has been little recent reduction in mortality rates, which can be as high as 30%. This article discusses severity designation at the time of diagnosis, reviews the pathophysiologic mechanisms so well characterized by the noxious combination of severe systemic inflammation and hypoperfusion, and provides a management algorithm that parallels current critical care strategies.


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