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

Abstract

Objective: To 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.

Design: A retrospective, before-after observational case series study was carried out.

Study period: 1 January 2001 to 31 December 2016, divided in 2 periods (pre-protocol 2001-2007, post-protocol 2008-2016).

Scope: An ICU with 48 beds and a recruitment population of 700,000 inhabitants.

Participants: AP patients admitted to the ICU, with no exclusion criteria.

Interventions: The recommendations proposed in the 7th Consensus Conference of the SEMICYUC on AP (5 September 2007) were applied in the second period.

Main variables of interest: Patient 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.

Results: The 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).

Conclusions: The implementation of a protocol could result in decreased mortality among AP patients admitted to the ICU.

Keywords: Acute pancreatitis; Clinical evolution; Clinical protocol; Conferencia de consenso; Consensus conference; Evolución clínica; Mortalidad; Mortality; Pancreatitis aguda; Protocolo.