Guidelines for the management of patients with severe acute pancreatitis 2021

Objective > To provide guidelines for the management of the intensive care patient with severe acute pancreatitis.Design > A consensus committee of 22 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommen-dations Assessment, Development and Evaluation (GRADE (R)) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.Methods > The last SFAR and CNGOF guidelines on the management of the patient with severe pancreatitis were published in 2001. The literature seems now sufficient for an update. The committee studied 14 questions within 3 fields. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and the evidence profiles were produced. The lite -rature review and recommendations were made according to the GRADE (R) methodology.Results > The experts' synthesis work and the application of the GRADE (R) method resulted in 24 recommendations. Among the formalized recommendations, 8 have high levels of evidence (GRADE 1 +/-) and 12 have low levels of evidence (GRADE 2 +/-). For 4 recommendations, the GRADE method could not be applied, resulting in expert opinions. Four questions did not find any response in the literature. After one round of scoring, strong agreement was reached for all the recommendations.Conclusions > There was strong agreement among experts for 24 recommendations to improve practices for the management of intensive care patients with severe acute pancreatitis.