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We recently received correspondence from Drs Scott, Patel, Carraretto, Tilley, and Quiney of Royal Surrey County Hospital in respect of the article by Simon Young and Jonathan Thompson on Severe acute pancreatitis (CEACCP 2008; 8: 125–8). They note that Early respiratory support in SAP with continuous positive airway pressure may reduce respiratory complication rates by maintaining lung volume and functional residual capacity. Early percutaneous ultrasound-guided pleural drainage with small catheters for pleural effusions may also confer a reduction in respiratory complications by maintaining dry aerated base of the lung.1 Although there was discussion about early resuscitation to try and avoid acute renal failure and avoidance of continuous veno-venous haemofiltration (CVVHF), we would like to add that CVVHF is being used