Resultados de la modificación de un protocolo de manejo para la pancreatitis aguda en Medicina Intensiva / Results of the modification of an acute pancreatitis management protocol in Intensive Care medicine

Objetivo: Conocer si la implantación de un protocolo para el manejo de la pancreatitis aguda (PA) en Medicina Intensiva (MI) redundó en la mejora de los resultados clínicos. Diseño: Serie de casos, observacional, retrospectivo, con un diseño antes-después. Periodo de estudio: 1/01/2001-31/12/2016, dividido en 2 periodos (preprotocolo 2001-2007; posprotocolo 2008-2016). Ámbito: Un servicio de MI con 48 camas y población de 700.000 habitantes. Participantes: Pacientes ingresados en MI con PA. No hubo criterios de exclusión. Intervenciones: Se aplicaron las recomendaciones propuestas en la 7.a Conferencia de Consenso (2007) de la SEMICYUC sobre la PA en el segundo periodo. Variables de interés principales: Edad, sexo, APACHE II, SOFA, periodo a estudio, días previos al ingreso en MI, tipo de nutrición, cirugía, profilaxis antibiótica, mortalidad hospitalaria, estancia en MI, estancia hospitalaria, clasificación basada en determinantes. Resultados: Doscientos ochenta y seis pacientes (94 preprotocolo, 192 posprotocolo), mortalidad hospitalaria de 66 casos (23,1%). La aplicación del protocolo supuso una disminución de la estancia hospitalaria previa al ingreso en MI, y de la profilaxis antibiótica, con un aumento del uso de nutrición enteral. Se evidenció un descenso de la mortalidad hospitalaria en el segundo periodo (35,1 vs. 17,18%, p=0,001), sin cambios significativos en la estancia en MI ni en la hospitalaria. En el análisis multivariante, la variable «periodo de tratamiento» mantuvo significación estadística respecto a la mortalidad hospitalaria (OR 0,34 en 2008-2016, IC 95% 0,15-0,74). Conclusiones: El establecimiento de un protocolo podría estar relacionado con un descenso de la mortalidad de los pacientes ingresados en MI por PA

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

Results of the modification of an acute pancreatitis management protocol in Intensive Care medicine. / Resultados de la modificación de un protocolo de manejo para la pancreatitis aguda en Medicina Intensiva.

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.