title: Admission, management and outcomes of acute pancreatitis in intensive care.
abstract: BACKGROUND
  A review of the management of acute pancreatitis (AP) at a tertiary intensive care unit (ICU) in Auckland, New Zealand, was published in 2004. This paper aims to update this series and identify changes in admission criteria, management and outcomes.
  
  
  METHODS
  A retrospective review of patients admitted to the Department of Critical Care Medicine, Auckland City Hospital, with AP from 2003 to 2014 was undertaken and data compared with the previous study (1988-2001).
  
  
  RESULTS
  Eighty-four patients (male 53, mean ± SD age = 56.9 ± 15 years) with 85 admissions to ICU from 2003 to 2014 were compared with 112 patients in the previous study. Maori were over-represented. Median duration of symptoms prior to admission to ICU decreased from 7 to 3 days. The proportion of total AP patients admitted to ICU halved and the mean Acute Physiology and Chronic Health Evaluation II score on admission decreased from mean 19.9 ± 8.2 SD to 15.4 ± 7.3 (P < 0.001). Two thirds of patients had persistent organ failure. The use of enteral feeding doubled from 46/112 (41%) to 71/85 (84%) (P < 0.001). The use of primary percutaneous drainage increased from 14/112 (13%) to 24/85 (28%) (P = 0.007). Rate of necrosectomy was similar (36/112 (32%) versus 20/85 (24%), P = 0.205), although minimally invasive necrosectomy was introduced. Overall hospital mortality decreased by 29% (P = 0.198).
  
  
  CONCLUSIONS
  There have been changes to the admission criteria and management in line with evolving guidelines and, overall, outcomes have improved.
authors.affiliation: Department of General Surgery, North Shore Hospital, North Shore City, New Zealand.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Russell
authors.affiliation: Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Anhubav
authors.initials: A
authors.lastname: Mittal
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Lisa
authors.initials: L
authors.lastname: Brown
authors.affiliation: Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Colin
authors.initials: C
authors.lastname: McArthur
authors.affiliation: Faculty of Science, University of Auckland, Auckland, New Zealand.
authors.forename: Anthony J R
authors.initials: AJR
authors.lastname: Phillips
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Max
authors.initials: M
authors.lastname: Petrov
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data*; D019468:Disease Management; D004322:Drainage / Q000706:statistics & numerical data; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009520:New Zealand / Q000453:epidemiology; D010195:Pancreatitis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: acute necrotizing pancreatitis; complications; intensive care units; minimally invasive surgical procedures; pancreatitis