{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:54:46Z","timestamp":1781646886252,"version":"3.54.5"},"reference-count":41,"publisher":"Royal College of Surgeons of England","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p> Severe acute pancreatitis remains a life-threatening condition, responsible for many disorders of homeostasis and organ dysfunction. By means of a mnemonic \u2018PANCREAS\u2019, eight important steps in the management of severe acute pancreatitis are highlighted. These steps follow the principle of goal-directed therapy and should be borne in mind after diagnosis and during clinical treatment. <\/jats:p><jats:p> The first step is perfusion: the goal is to reach a central venous pressure of 12\u201315mmHg, urinary output 0.5\u20131ml\/kg\/hour and inferior vena cava collapse index greater than 48%. Next is analgesia: multimodal, systemic and combined pharmacological agent and epidural block are possibilities. Third is nutrition: precocity, enteral feeding in gastric or post-pyloric position. Parenteral nutrition works best in difficult cases to achieve the individual total caloric value. Fourth is clinical: mild, moderate or severe pancreatitis according to the Atlanta criteria. Radiology is fifth: abdominal computed tomography on the fourth day for prognosis or to modify management. Endoscopy is sixth: endoscopic retrograde cholangiopancreatography (cholangitis, unpredicted clinical course and ascending jaundice); management of pancreatic fluid collection and \u2018walled-off necrosis\u2019. Antibiotics come next: infectious complications are common causes of morbidity. The only rational indication for antibiotics is documented pancreatic infection. The last step is surgery: the dogma is represented by the \u2018three Ds\u2019 (delay, drain, debride). The preferred method is a minimally invasive step-up approach, which allows for gradually more invasive procedures when the previous treatment fails. <\/jats:p>","DOI":"10.1308\/rcsann.2020.0029","type":"journal-article","created":{"date-parts":[[2020,3,11]],"date-time":"2020-03-11T15:16:34Z","timestamp":1583939794000},"page":"555-559","source":"Crossref","is-referenced-by-count":24,"title":["Severe acute pancreatitis: eight fundamental steps revised according to the \u2018PANCREAS\u2019 acronym"],"prefix":"10.1308","volume":"102","author":[{"given":"CA","family":"Gomes","sequence":"first","affiliation":[{"name":"Therezinha de Jesus University Hospital, Juiz de Fora, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Di Saverio","sequence":"additional","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust, Addenbrooke\u2019s Hospital, Cambridge, 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