Early Enteral Nutrition Prevents Intra‐abdominal Hypertension and Reduces the Severity of Severe Acute Pancreatitis Compared with Delayed Enteral Nutrition: A Prospective Pilot Study

Sun, Jianfang; Li, Weiqin; Ke, Lu; Tong, Zhihui; Ni, Haibin; Li, Gang; Zhang, Luyao; Nie, Yan; Wang, Xinying; Ye, Xianghong; Li, Ning; Li, Jieshou

doi:10.1007/s00268-013-2087-5

Cited by 55 publications

(36 citation statements)

References 52 publications

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“…Rationale: The improved outcome in moderate to severe acute pancreatitis with early EN is based primarily on studies comparing EN with PN, and PN in such cases may be a negative control. Limited support comes from studies showing benefit (trend toward reduced mortality) from early EN compared with STD 338 ‐ 340 and improved outcomes from early EN (reduced infection, organ failure, ICU LOS, and SIRS) versus delayed EN 341 , 342 . What is not known is what percentage of patients with moderate to severe acute pancreatitis would tolerate advancing to oral diet (similar to the data on patients with mild disease) within 3–4 days from the time of admission and thus not need specialized nutrition therapy.…”

Section: Acute Pancreatitismentioning

confidence: 99%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

McClave

Taylor

Martindale

et al. 2016

J Parenter Enteral Nutr

2,567

1,248

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Section: Acute Pancreatitismentioning

confidence: 99%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

McClave

Taylor

Martindale

et al. 2016

J Parenter Enteral Nutr

2,567

1,248

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“…Patients with moderate to severe acute pancreatitis refuse oral feeding due to nausea, vomiting and abdominal pain secondary to gastric stasis and abdominal distention following pancreas in ammation. Food intolerance is also present in early enteral nutrition 17 .…”

Section: Discussionmentioning

confidence: 99%

Ketorolac and Predicted Severe Acute Pancreatitis: A Randomized, Controlled Clinical Trial

Shahbazi

Shariatpanahi

Shahbazi

2020

Preprint

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Background: We evaluated effect of ketorolac on reducing the severity of acute pancreatitis.Methods: Fifty six adult patients, with predicted severe acute pancreatitis were randomly divided into two groups. The patients in the study group received intravenous ketorolac, 10 mg, 3 times daily from time of enrollment for a maximum of 5 days as needed along with standard medical treatment. Primary outcome measure was the change in the serum level of hs-CRP. Patients were also followed up in terms of hospitalization duration, need for ICU care, development of organ failure, persistent organ failure, pancreatic necrosis, nutritional assessment and mortality. The study was continued to gather clinical follow up information up to 4 months.Results: Serum level of hs-CRP was significantly lower in the ketorolac group than in the control group on days 3, 4, and 5. Organ failure, pseudocyst formation, acute necrotic collection and intensive care unit transfer occurred non-significantly more in the control group than in the ketorolac group. Median days of hospitalization were significantly lower in the study group than in the control group. Based on the Log rank test, survival within 4 months was marginally lower in the control group (P=0.076). The time to start feeding was significantly shorter in the study group than in the control group with no need to artificial enteral nutrition in the ketorolac group. Frequency of NPO (not per oral) was significantly lower in the ketorolac group.Conclusion: The use of ketorolac may improve feeding and clinical outcomes in severe acute pancreatitis.ClinicalTrials.gov: NCT02885441, Date: August 31, 2016

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“…[35] In addition, early EN (<48 h) was found to have a protective effect against the development of intra-abdominal hypertension in SAP. [36] A recent meta-analysis revealed that NG was equivalent to NJ feeding in terms of mortality (relative risk [RR] = 0.69), risk of aspiration (RR = 0.46), exacerbation of pain (RR = 0.94), and achieving nutritional targets ( P = 0.97). [3437] At our center, we attempt to initiate NG feeds within 48 h of admission.…”

Section: Nutrition In Acute Pancreatitismentioning

confidence: 99%

Current concepts in the management of acute pancreatitis

Srinivasan

Venkatakrishnan

Sambandam

et al. 2016

J Family Med Prim Care

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Guidelines for the management of acute pancreatitis (AP) are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The “step up” approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients.

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Early Enteral Nutrition Prevents Intra‐abdominal Hypertension and Reduces the Severity of Severe Acute Pancreatitis Compared with Delayed Enteral Nutrition: A Prospective Pilot Study

Cited by 55 publications

References 52 publications

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Ketorolac and Predicted Severe Acute Pancreatitis: A Randomized, Controlled Clinical Trial

Current concepts in the management of acute pancreatitis

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