Development of a Web-based System for Targeted Fluid Resuscitation in Acute Pancreatitis

Abstract

Purpose: Vigorous fluid resuscitation plays an important role in the early management of acute pancreatitis. Current practices for fluid resuscitation vary widely. The purpose of this study was to develop a targeted, weight-based strategy for standardization of early fluid resuscitation in patients with acute pancreatitis. Methods: Gastroenterology, Nephrology and Emergency Department faculty established parameters for targeted fluid resuscitation. The resulting protocol directs fluid administration efforts according to change in blood urea nitrogen (BUN) level at two checkpoints (8- and 16 hours after admission). We then developed an electronic, web-based platform to enable real-time implementation of the fluid resuscitation protocol. A pilot study was conducted to assess safety and feasibility of the newly developed web-based fluid resuscitation strategy. Results: We prospectively enrolled 6 patients in the pilot study. The protocol was successfully implemented at each checkpoint using the online system. BUN levels decreased at 24 hours among all enrolled patients. There was one adverse event (cholangitis) that was unrelated to study participation. Characteristics of the patients and fluid resuscitation parameters are listed in Table 1.Table 1: Characteristics of pilot study patientsConclusion: We have developed and pilot tested a web-based fluid resuscitation strategy for use in the first 24 hours of hospitalization in acute pancreatitis. This strategy can now be compared to standard methods of fluid resuscitation to evaluate for potential improvement in patient care.