Acute pancreatitis: A prospective study and some factors in mortality
A prospective study of 213 consecutive cases of acute pancreatitis admitted to one hospital over a 4 year period were managed by a careful conservative regime which did not include the administration of trasylol (Aprotinin) or glucagon. An overall mortality rate of 10.8% was recorded. There was no significant difference in mortality between patients with biliary pathology (50% of the patients) and those with alcohol related disease (23% of the patients). Mortality was high in patients submitted to diagnostic laparotomy in the acute phase of illness and five of 13 such cases died. Arterial blood gas measurements in 70 cases revealed 40% of PO2 levels less than 60 mm Hg breathing air. Arterial hypoxia may be a major factor in determining outcome of the disease and this factor may be especially important in the poor clinical course of patients submitted to laparotomy. Humidified oxygen (8 litres/min via Hudson or Ventimask) became routine policy half way through the study and since its introduction the mortality rate for comparable groups of patients over the age of 60 has fallen from 24 to 12%. Acute respiratory insufficiency in acute pancreatitis requires further investigation but may be important in the elderly patient, especially if submitted to laparotomy in the acute phase of illness.