Early Rehabilitation for Severe Acute Pancreatitis (ERN-SAP)

Effect of a Structured Early Rehabilitation Program on Long-Term Functional Recovery, Quality of Life, and Survival in Patients With Severe Acute Pancreatitis: A 5-Year Randomized Controlled Trial

This prospective, randomized controlled trial investigates the efficacy of a structured early rehabilitation nursing (ERN) program compared to usual care in patients with severe acute pancreatitis (SAP). Four hundred patients admitted to the intensive care unit (ICU) were randomized to either receive the ERN intervention or usual care. The study aims to evaluate the effects of ERN on ICU and hospital length of stay, systemic inflammation, physical function, long-term quality of life, and one-year survival.

Patients with severe acute pancreatitis (SAP) often experience prolonged immobilization in the ICU, leading to complications such as ICU-acquired weakness (ICU-AW), extended hospital stays, and poor long-term functional outcomes. While early rehabilitation is beneficial in general critical care, its application in SAP is not well-established. This study was designed to address this gap by evaluating a comprehensive, structured early rehabilitation nursing (ERN) program. The program includes progressive mobilization, respiratory therapy, and psychological support, initiated within 48 hours of ICU admission. The hypothesis is that the ERN program, compared to usual care, will attenuate systemic inflammation, accelerate physical recovery, reduce length of stay, and lead to superior long-term functional independence, quality of life, and 1-year survival in patients with SAP.

Inclusion Criteria:

1. Age 18 to 75 years.
2. A diagnosis of SAP according to the 2012 revised Atlanta classification.
3. Admission to the ICU within 72 hours of symptom onset.
4. An anticipated ICU stay of more than 48 hours.

Exclusion Criteria:

1. Pre-existing conditions precluding rehabilitation (e.g., severe neuromuscular disease, unstable spinal fractures).
2. Acute myocardial infarction or unstable cardiac arrhythmia.
3. Intracranial hypertension.
4. Active gastrointestinal bleeding.
5. Pregnancy.
6. Patient or family refusal.