Thread by @PulmCrit

a fresh review article on pancreatitis in the Lancet is some hot garbage. as Eduardo rightly pointed out 👇, the bit on fluid resuscitation is nuts. but there are more errors, which merit a short #rantorial... 1/4

https://twitter.com/ArgaizR/status/1302121346286092289

one RCT showed that delayed feeding was OK... in a population with mostly *mild* illness. the authors wrongly extrapolate this to *all* patients. esp for an intubated patient, there is no reason to delay feeding for 72 hours! #rantorial 2/4
emcrit.org/ibcc/pancreati…

regarding analgesia, the authors suggest that opioids could be used to avoid non-opioids! 🤬🤬 this is backwards. the goal is generally to use non-opioids to reduce the opioid dose, and thereby *avoid* opioid-induced side effects (especially illeus). #3/4
emcrit.org/ibcc/pain/

finally, there is no mention of how to treat hypertriglyceridemic pancreatitis. this is often the 3rd leading cause of pancreatitis & will be seen regularly in any large ICU. it requires specific management, which deserves to at least be mentioned 4/4
emcrit.org/ibcc/hypertag/