JPN Guidelines for the management of acute pancreatitis: medical management of acute pancreatitis
Kazunori Takeda1, Tadahiro Takada2,*, Yoshifumi Kawarada3, Koichi Hirata4, Toshihiko Mayumi5, Masahiro Yoshida2, Miho Sekimoto6, Masahiko Hirota7, Yasutoshi Kimura4, Shuji Isaji8, Masaru Koizumi9, Makoto Otsuki10,**, andSeiki Matsuno11,***
Department of Surgery, National Hospital Organization Sendai Medical Center, 2-8-8 Miyagino, Miyagino-ku, Sendai 983-8520, Japan Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan 3 Ueno Municipal Hospital, Mie, Japan 4 First Department of Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan 5 Department of Emergency andCritical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan 6 Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan 7 Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan 8 Department of Hepatobiliary Pancreatic Surgery and Breast Surgery, Mie UniversityGraduate School of Medicine, Mie, Japan 9 Ohara Medical Center Hospital, Fukushima, Japan 10 Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyushu, Japan 11 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
Abstract The basic principles of the initial managementof acute pancreatitis are adequate monitoring of vital signs, ﬂuid replacement, correction of any electrolyte imbalance, nutritional support, and the prevention of local and systemic complications. Patients with severe acute pancreatitis should be transferred to a medical facility where adequate monitoring and intensive medical care are available. Strict cardiovascular and respiratory monitoringis mandatory for maintaining the cardiopulmonary system in patients with severe acute pancreatitis. Maximum ﬂuid replacement is needed to stabilize the cardiovascular system. Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with necrotizing pancreatitis. Although the efﬁcacy of the intravenous administration of protease inhibitors is still amatter of controversy, there is a consensus in Japan that a large dose of a synthetic protease inhibitor should be given to patients with severe acute pancreatitis in order to prevent organ failure and other complications. Enteral feeding is superior to parenteral nutrition when it comes to the nutritional support of patients with severe acute pancreatitis. The JPN Guidelines recommend, as optionalmeasures, blood puriﬁcation therapy and continuous regional arterial infusion
of a protease inhibitor and antibiotics, depending on the patient’s condition. Key words Acute pancreatitis · Conservative management · Antibiotics · Nutritional support · Protease inhibitor
Clinical questions CQ1. Is adequate ﬂuid replacement crucial in the management of acute pancreatitis? CQ2. Is pain control byanalgesia crucial in acute pancreatitis? CQ3. Are nasogastric suction and H2 blockers necessary? CQ4. Is the continuous intravenous application of a large dose of a protease inhibitor useful for severe acute pancreatitis? CQ5. Is enteral nutrition superior to total parenteral nutrition as nutritional support in severe acute pancreatitis? CQ6. Is prophylactic antibiotic administration necessary forthe prevention of infections in severe acute pancreatitis? CQ7. Is blood puriﬁcation therapy useful in severe acute pancreatitis? CQ8. Does continuous regional arterial infusion of protease inhibitors and antibiotics reduce the mortality rate and incidence of infectious complications in acute necrotizing pancreatitis?
Offprint requests to: K. Takeda * President, Japanese Society of Emergency...