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lüll Contemporary management of infected necrosis complicating severe acute pancreatitis Jamdar S; Siriwardena AKCrit Care 2006[Feb]; 10 (1): 101Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of necrosis remains the mainstay for establishment of infection. Pharmacological intervention includes antibiotic therapy as an adjunct to surgical debridement/drainage and, more recently, drotrecogin alfa. Specific concerns remain regarding the suitability of drotrecogin alfa in this setting. Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward 'less drastic' surgical interventions.|Adult[MESH]|Aged[MESH]|Anti-Bacterial Agents/therapeutic use[MESH]|Disease Management[MESH]|Drainage/methods[MESH]|Humans[MESH]|Middle Aged[MESH]|Pancreatitis, Acute Necrotizing/*diagnosis/surgery/*therapy[MESH]|Pancreatitis/diagnosis/surgery/therapy[MESH] |