Acute pancreatitis in the surgical intensive care unit

Pancreatitis can tax all the resources of the surgical intensive care unit. Though some triggers of the disease are understood, the mechanism of progression remains uncertain. Most occurrences are mild and self-limited, but occasionally they progress to a more severe, fulminant form that causes tremendous metabolic and physiologic stress. The purpose of Ranson's classic criteria is identification of the patient at risk for the most severe disease and stratification of therapy to control disease progression and support the systemic effects of the resultant inflammation (1). Every physician, regardless of specialty, has frantically scrambled at some point in training to remember these criteria in preparation for a discussion of acute pancreatitis. What they identify are signs reflecting the severity of the inflammatory response to tissue injury. Similar responses are found in other inflammatory states, such as sepsis, severe trauma, and massive hemorrhage.