Synopsis
Recognise persistent respiratory, cardiovascular or renal failure in acute pancreatitis, organise critical-care support, nutrition and complication surveillance, and avoid interventions that worsen early inflammatory injury.
- NICE defines severe acute pancreatitis by single or multiple organ failure persisting for more than forty-eight hours; transient organ failure still marks at least moderately severe disease.
- Respiratory failure, shock and acute kidney injury may evolve during the first days, so care must follow trends in oxygen, perfusion, cognition and urine rather than lipase or one admission score.
- Involve critical care early for increasing oxygen requirement, hypotension, oliguria, acidosis, altered consciousness or escalating support; transfer to a specialist pancreatic centre when needed expertise is absent.
Key red flags
Continuing hypoxaemia, rising oxygen or ventilatory requirement and inflammatory lung injury beyond forty-eight hours meets severe-disease physiology and needs critical-care support.
Investigation priorities
Identify the onset, persistence and response of cardiovascular, respiratory and renal organ failure.
Management branches
Respiratory, cardiovascular or renal dysfunction is persistent, progressive or needs advanced monitoring and treatment.
- Transfer or admit to an appropriate critical-care setting and establish explicit targets for oxygenation, pressure, perfusion, urine output and sedation.
- Reassess intravascular responsiveness and cumulative balance before further fluid, adding vasopressors, ventilation or renal replacement through critical-care protocols.
Key medicines
Noradrenaline for vasodilatory shockTitrate a continuous critical-care infusion to an individual perfusion target after appropriate volume assessment, using local vascular-access and monitoring standards.
Therapeutic antimicrobials for proven infectionChoose a microbiology-led intravenous regimen at current BNF doses for the identified source, renal function and local resistance pattern.