Table 1. Summary of recommendations.
| SFAR recommendation | IAP/APA | AGA |
|---|---|---|
| Field 1: Evaluation and admission to critical care of the adult patient | ||
| (2+) Intensive care unit admission probably recommended for patients with organ failure with or without necrosis, or acute pancreatitis at risk of becoming severe | Agree | – |
| (1+) CT scan recommended if diagnosis unclear after history and lipase levels, if clinically worsening, or if not responding to initial treatment | Agree | – |
| (1+) Liver enzymes, triglycerides, calcium, and abdominal ultrasound routinely recommended | Agree | – |
| (1+) Intraabdominal pressure monitoring recommended in the first 72 h if invasively ventilated | Agree | – |
| Field 2: Treatment during the initial phase | ||
| (2−) Resuscitation with 3–5 mL/kg/h during the first 24 h probably not recommended to reduce mortality, acute kidney injury, or hospital length of stay; rather, base it on results of hemodynamic response | Disagree | Disagree |
| (2−) Probiotics probably not recommended to reduce mortality or respiratory complications | Agree | – |
| (1+) Enteral nutrition recommended over parenteral nutrition to reduce mortality, systemic infection, and possibly local infection | Agree | Agree |
| (1−) Systematic implementation of early enteral nutrition (24–48 h) not recommended over later nutrition to reduce mortality, infections, or organ failure | – | – |
| (1−) Systematic nasojejunal tubes not recommended over nasogastric tubes to improve feeding tolerance | Agree | Agree |
| (2−) Semi-elemental or elemental mixtures and immuno-nutrition probably not recommended over standard polymeric mixtures for enteral feeding | Agree | – |
| (2+) If parenteral nutrition required, supplementation with intravenous glutamine probably recommended to reduce mortality, infections, and length of stay | – | – |
| (2−) Additive antioxidants to nutritional formula probably not recommended | – | – |
| (1+) In biliary pancreatitis, urgent ERCP only recommended for cases of cholangitis | Agree | Agree |
| (2−) Unconventional drug therapies (somatostatin, insulin, nonsteroidal anti-inflammatories, various other small molecules) probably not recommended | – | – |
| (EO) Therapeutic plasma exchange recommended for hypertriglyceridemia >1,000 mg/dL if not rapidly reduced with fibrates, insulin, and heparin | – | – |
| Field 3: Treatment and management of progressive complications | ||
| (2−) Prophylactic antimicrobials probably not recommended to reduce mortality, infected necrosis, or other infections | Agree | Agree |
| (2+) Procalcitonin and CT scan probably recommended over C-reactive protein for diagnosing infected necrosis | – | – |
| (EO) Fine needle aspiration for diagnosing infected necrosis not recommended in the absence of clinical signs of sepsis or gas on CT scan | Agree | – |
| (2+) Drainage of infected necrosis probably recommended over just antibiotics alone | Agree | – |
| (1+) A graduated, step-up approach with endoscopic or percutaneous needle drainage recommended | Agree | – |
| (EO) Transfer to an adequately equipped center recommended if no minimally invasive drainage options | Agree | – |
| (2+) Antibiotic coverage targeting resistant Enterobacter species, Enterococcus faecium, Pseudomonas aeruginosa, and yeast probably recommended | – | – |
| (EO) Direct fluid sampling or positive blood cultures to guide targeted antibiotic selection | – | – |
| (2+) Endovascular treatment for gastrointestinal hemorrhage probably recommended over open surgical approach | – | – |
Recommendation strength: 1+: recommended; 2+: probably recommended; 1−: not recommended; 2−: probably not recommended; EO: expert opinion. SFAR, French Society of Anesthesia and Intensive Care Medicine; IAP, International Association of Pancreatology; APA, American Pancreatic Association; AGA, American Gastroenterological Association; CT, computed tomography; ERCP, endoscopic retrograde cholangiopancreatography.