Guidelines for the management of patients with severe acute pancreatitis, 2021

Samir Jaber¹, Marc Garnier², Karim Asehnoune³, Fanny Bounes⁴, Louis Buscail⁵, Jean-Baptiste Chevaux⁶, Claire Dahyot-Fizelier⁷, Lucie Darrivere⁸, Matthieu Jabaudon⁹, Olivier Joannes-Boyau¹⁰, Yoann Launey¹¹, Eric Levesque¹², Philippe Levy¹³, Philippe Montravers¹⁴, Laurent Muller¹⁵, Thomas Rimmelé¹⁶, Claire Roger¹⁷, Céline Savoye-Collet¹⁸, Philippe Seguin¹⁹, Jean-Pierre Tasu²⁰, Ronan Thibault²¹, Geoffroy Vanbiervliet²², Emmanuel Weiss²³, Audrey De Jong²⁴

Affiliations

¹ Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France. Electronic address: s-jaber@chu-montpellier.fr.
² Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France.
³ Service d'Anesthésie, Réanimation chirurgicale, Hôtel Dieu/HME, CHU Nantes, Nantes cedex 1, France; Inserm, UMR 1064 CR2TI, team 6, France.
⁴ Toulouse University Hospital, Anaesthesia Critical Care and Perioperative Medicine Department, Toulouse, France; Équipe INSERM Pr Payrastre, I2MC, Université Paul Sabatier Toulouse III, Toulouse, France.
⁵ Department of Gastroenterology & Pancreatology, University of Toulouse, Rangueil Hospital, Toulouse, France.
⁶ Service HépatoGastroEntérologie, Brabois Adultes, CHRU Nancy, France.
⁷ Anaesthesiology and Intensive Care Department, University hospital of Poitiers, Poitiers, France; INSERM U1070, University of Poitiers, Poitiers, France.
⁸ Department of Anaesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.
⁹ Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France.
¹⁰ Service d'Anesthésie-Réanimation SUD, CHU de Bordeaux, Hôpital Magellan, Bordeaux, France.
¹¹ Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France.
¹² Department of Anaesthesia and Surgical Intensive Care, AP-HP, Henri Mondor Hospital, Créteil, France; Université Paris-Est Creteil, EnvA, DYNAMiC, Faculté de Santé de Créteil, Creteil, France.
¹³ Service de Pancréatologie et d'Oncologie Digestive, DMU DIGEST, Université de Paris, Hôpital Beaujon, APHP, Clichy, France.
¹⁴ Université de Paris Cité, INSERM UMR 1152 - PHERE, Paris, France; Département d'Anesthésie-Réanimation, APHP, CHU Bichat-Claude Bernard, DMU PARABOL, APHP, Paris, France.
¹⁵ Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France.
¹⁶ Département d'anesthésie-réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France; EA 7426: Pathophysiology of Injury-induced Immunosuppression, Pi3, Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France.
¹⁷ Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France; Department of Intensive care medicine, Division of Anaesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.
¹⁸ Department of Radiology, Normandie University, UNIROUEN, Quantif-LITIS EA 4108, Rouen University Hospital-Charles Nicolle, Rouen, France.
¹⁹ Service d'Anesthésie Réanimation 1, Réanimation chirurgicale, CHU de Rennes, Rennes, France.
²⁰ Service de radiologie diagnostique et interventionnelle, CHU de Poitiers, Poitiers, France; LaTim, UBO and INSERM 1101, University of Brest, Brest, France.
²¹ Service Endocrinologie-Diabétologie-Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France.
²² Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France.
²³ Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France.
²⁴ Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France.

PMID: 35636304
DOI: 10.1016/j.accpm.2022.101060

Practice Guideline

Guidelines for the management of patients with severe acute pancreatitis, 2021

Samir Jaber et al. Anaesth Crit Care Pain Med. 2022 Jun.

. 2022 Jun;41(3):101060.

doi: 10.1016/j.accpm.2022.101060. Epub 2022 May 25.

Authors

Affiliations

¹ Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France. Electronic address: s-jaber@chu-montpellier.fr.
² Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France.
³ Service d'Anesthésie, Réanimation chirurgicale, Hôtel Dieu/HME, CHU Nantes, Nantes cedex 1, France; Inserm, UMR 1064 CR2TI, team 6, France.
⁴ Toulouse University Hospital, Anaesthesia Critical Care and Perioperative Medicine Department, Toulouse, France; Équipe INSERM Pr Payrastre, I2MC, Université Paul Sabatier Toulouse III, Toulouse, France.
⁵ Department of Gastroenterology & Pancreatology, University of Toulouse, Rangueil Hospital, Toulouse, France.
⁶ Service HépatoGastroEntérologie, Brabois Adultes, CHRU Nancy, France.
⁷ Anaesthesiology and Intensive Care Department, University hospital of Poitiers, Poitiers, France; INSERM U1070, University of Poitiers, Poitiers, France.
⁸ Department of Anaesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.
⁹ Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France.
¹⁰ Service d'Anesthésie-Réanimation SUD, CHU de Bordeaux, Hôpital Magellan, Bordeaux, France.
¹¹ Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France.
¹² Department of Anaesthesia and Surgical Intensive Care, AP-HP, Henri Mondor Hospital, Créteil, France; Université Paris-Est Creteil, EnvA, DYNAMiC, Faculté de Santé de Créteil, Creteil, France.
¹³ Service de Pancréatologie et d'Oncologie Digestive, DMU DIGEST, Université de Paris, Hôpital Beaujon, APHP, Clichy, France.
¹⁴ Université de Paris Cité, INSERM UMR 1152 - PHERE, Paris, France; Département d'Anesthésie-Réanimation, APHP, CHU Bichat-Claude Bernard, DMU PARABOL, APHP, Paris, France.
¹⁵ Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France.
¹⁶ Département d'anesthésie-réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France; EA 7426: Pathophysiology of Injury-induced Immunosuppression, Pi3, Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France.
¹⁷ Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France; Department of Intensive care medicine, Division of Anaesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.
¹⁸ Department of Radiology, Normandie University, UNIROUEN, Quantif-LITIS EA 4108, Rouen University Hospital-Charles Nicolle, Rouen, France.
¹⁹ Service d'Anesthésie Réanimation 1, Réanimation chirurgicale, CHU de Rennes, Rennes, France.
²⁰ Service de radiologie diagnostique et interventionnelle, CHU de Poitiers, Poitiers, France; LaTim, UBO and INSERM 1101, University of Brest, Brest, France.
²¹ Service Endocrinologie-Diabétologie-Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France.
²² Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France.
²³ Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France.
²⁴ Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France.

PMID: 35636304
DOI: 10.1016/j.accpm.2022.101060

Abstract

Objective: To provide guidelines for the management of the intensive care patient with severe acute pancreatitis.

Design: A consensus committee of 22 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.

Methods: The most recent SFAR and SNFGE guidelines on the management of the patient with severe pancreatitis were published in 2001. The literature now is sufficient for an update. The committee studied 14 questions within 3 fields. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and the relevant evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.

Results: The experts' synthesis work and their application of the GRADE® method resulted in 24 recommendations. Among the formalised recommendations, 8 have high levels of evidence (GRADE 1+/-) and 12 have moderate levels of evidence (GRADE 2+/-). For 4 recommendations, the GRADE method could not be applied, resulting in expert opinions. Four questions did not find any response in the literature. After one round of scoring, strong agreement was reached for all the recommendations.

Conclusions: There was strong agreement among experts for 24 recommendations to improve practices for the management of intensive care patients with severe acute pancreatitis.

Keywords: Acute respiratory distress syndrome; Critical care; Guidelines; Intensive care unit; Sepsis; Severe acute pancreatitis.

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Comment in

Improving the management of severe acute pancreatitis: The new guidelines from the French Society of Anaesthesia and Intensive Care Medicine.
Laterre PF, Collienne C. Laterre PF, et al. Anaesth Crit Care Pain Med. 2022 Jun;41(3):101103. doi: 10.1016/j.accpm.2022.101103. Anaesth Crit Care Pain Med. 2022. PMID: 35715021 No abstract available.
Management of severe acute pancreatitis: all hands to the pump.
Nakai Y. Nakai Y. Hepatobiliary Surg Nutr. 2022 Dec;11(6):903-905. doi: 10.21037/hbsn-22-529. Hepatobiliary Surg Nutr. 2022. PMID: 36523937 Free PMC article. No abstract available.

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Guidelines for the management of patients with severe acute pancreatitis, 2021

Affiliations

Guidelines for the management of patients with severe acute pancreatitis, 2021

Authors

Affiliations

Abstract

Comment in

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LinkOut - more resources

Full Text Sources

Medical