Severe pancreatitis is a critical inflammatory condition of the pancreas that leads to systemic illness, organ dysfunction, and a high risk of mortality, necessitating intensive care unit management. Unlike mild pancreatitis, severe cases are characterized by persistent organ failure, extensive inflammation, fluid shifts, and metabolic disturbances. Common causes include gallstones, alcohol use, hypertriglyceridemia, medications, and post-procedural complications.

Patients with severe pancreatitis often present with intense abdominal pain, vomiting, fever, hypotension, respiratory distress, and altered mental status. The inflammatory response can rapidly spread beyond the pancreas, causing acute respiratory failure, kidney injury, circulatory shock, and coagulopathy. ICU admission is essential for continuous monitoring and organ support.

ICU management focuses on aggressive supportive care rather than surgical intervention in the early phase. Adequate fluid resuscitation is critical to maintain organ perfusion, but it must be carefully balanced to avoid fluid overload and worsening respiratory failure. Pain control, oxygen therapy, and close monitoring of vital signs are essential components of care.

Severe pancreatitis is frequently complicated by respiratory failure requiring mechanical ventilation, acute kidney injury requiring renal replacement therapy, and sepsis due to pancreatic necrosis or secondary infection. Nutritional support, preferably enteral, plays a crucial role in recovery and reducing complications.

The disease course is often prolonged, with patients requiring extended ICU stays and repeated imaging and interventions. Early identification of complications and timely escalation of care significantly improve outcomes.

Through vigilant monitoring and comprehensive organ support, ICU teams play a central role in reducing mortality and long-term complications associated with severe pancreatitis.