Exocrine pancreatic involvement in critically ill patients.
OBJECTIVE
To learn about the prevalence, pathophysiology, and treatment of exocrine pancreatic involvement in critically ill patients.


RESULTS
Elevations in the levels of pancreatic enzymes are observed in up to 80% of intensive care patients. Most of these patients do not develop clinically relevant pancreatitis. However, elevations in enzyme levels do represent pancreatic damage with a risk of complications. Different factors have been discussed, which may contribute to pancreatic damage in critically ill patients. These include splanchnic hypoperfusion during shock or major surgery, bacterial translocation, elevated triglyceride levels, development of biliary sluge, and biliary pancreatitis, as well as several drugs. Imaging procedures and inflammatory markers help to identify relevant disease. Several therapeutic options have been discussed recently with a focus on early enteral nutrition.


CONCLUSIONS
Pancreatic damage is frequently observed in critically ill patients. Although in most of these patients, this is without major clinical consequences, some patients develop relevant pancreatitis, which contributes to morbidity and mortality. Risk factors have been identified and therapeutic strategies have been changed.
Hardt
Philip D
PD
University Hospital Giessen and Marburg, Giessen Site, Third Medical Department, Giessen, Germany. philip.d.hardt@innere.med.uni-giessen.de
Mayer
Konstantin
K
Ewald
Nils
N
D000681:Amylases / Q000097:blood; D001646:Bile / Q000378:metabolism; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D006801:Humans; D008049:Lipase / Q000097:blood; D018529:Nutritional Support; D046790:Pancreas, Exocrine / Q000382:microbiology / Q000503:physiopathology*; D010195:Pancreatitis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015995:Prevalence; D014280:Triglycerides / Q000378:metabolism
D014280:Triglycerides; D008049:Lipase; D000681:Amylases