Was this a proper approach for Necrotizing pancreatitis?

My elder brother expired due to Pancreatitis some time ago. Through this forum, I would like to ask was the approach of both of the hospitals correct?

Hospital 1, Private Teritary care

Patient admits on 22/4/19 with severe abdomen pain.

Explained that he has severe pancreatitis, ERCP would be needed and there might be a kidney Injury or a lung Injury in the course until diagnosis is achieved.

ERCP done on 23/4/19 with 12 stones removed from the pancreatic duct. A follow up MRI says Necrotizing Pancreatitis with free fluid seen in the abdomen. On the same day, Patient is put on a ventilator after complaint of respiratory distress. USG says Mild PE in the left lung.

Patient is kept sedated until 27/4/19 when he is reffered to another tertiary care hospital. BP remains normal where pulse remains around 130-140. High grade fever spikes are observed.

Hospital 2, Government Tertiary care hospital and the biggest in North India

Upon recieving in ICU in the other hospital, they continue with Antibiotics the previous hospital prescribed along with adding Liposomal B with Imipenem.

Drains are added on the both left and right side of the abdomen(PCD) in an expectation that free fluid with Necrosis would be drained. High grade fever spikes continue although BP remains normal and pulse remains high. This process is continued until 9/5/2019 when open Necrosectomy is performed.

Necrosectomy is successful in controlling fever, but another complication arised. Internal Gastro bleeding is noted on 10/5/19(BP 46/33) and coil embolization on the abdominal nerve is performed. On 11/5/19 bleeding is noted again and as a result the necrosectomy surgery is opened and packing is done. This stops the bleeding for 36 hours when right drain starts to Bleed again suddenly. Surgery is opened again and bleeding stops. (BP 33/26). Upon shifting to ICU patient has 2 cardiac arrests and subsequently he expires. Reason:Systemic Sepsis.

Thank you

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