Patients with acute pancreatitis are considered to have severe acute pancreatitis (SAP) if they manifest signs of shock, respiratory failure, renal faliure, or GI bleeding.
SAP is almost universally associated with pulmonary dysfunction, typically manifested as an SpO2 < 90% in the first few hours of illness.
In fact, ARDS develops in at least one-third of patients with SAP.
Take Home Point: Pay close attention to the patient with acute pancreatitis and a low pulse oximetry reading, as many will rapidly deteriorate from ARDS. In those who deteriorate, early intubation with implementation of lung protective ventilatory strategies is indicated.
Greer SE, Burchard KW. Acute pancreatitis and critical illness: A pancreatic tale of hypoperfusion and inflammation. Chest 2009;136:1413-19.