Fluid Resuscitation In Acute Pancreatitis Research Articles

Role of Fluid Resuscitation in Acute Pancreatitis: A Randomised Control Trial

Role of Fluid Resuscitation in Acute Pancreatitis: A Randomised Control Trial

Acute Pancreatitis Review.

Acute pancreatitis, a prevalent illness with devastating consequences, poses a grave threat to those affected. There has been a steady increase in the occurrence of acute pancreatitis at about 3% per year from 1961 to 2016. There are 3 main guidelines on acute pancreatitis, including the American College of Gastroenterology, the International Association of Pancreatology/American Pancreatic Association guideline in 2013, and the American Gastroenterological Association guideline in 2018. However, several milestone studies have been published since then. We hereby reviewed the current acute pancreatitis guidelines with an update on clinical practicechanging literature. The aggressive or moderate fluid resuscitation in acute pancreatitis (WATERFALL) trial recommended fluid resuscitation with lactated Ringer's solution at a moderate aggressive rate. All guidelines did not recommend prophylactic antibiotics use. Early enteral feeding reduces morbidity. A clear liquid diet is no longer recommended. Nutrition with nasogastric or nasojejunal feeding does not have a difference. The upcoming high vs. low-energy administration in the early phase of acute pancreatitis (GOULASH) trial will provide more information on the impact of calorie intake. Pain management should be individualized based on the degree of pain and severity of pancreatitis. In patients with moderate to severe and severe acute pancreatitis, a step-down approach with epidural analgesia can be considered for moderate to severe pain. The management of acute pancreatitis has evolved. New research on the impact of electrolytes, pharmacologic agents, the role of anticoagulants, and nutrition support will provide scientific and clinical evidence to improve patient care and decrease morbidity and mortality.

Aggressive versus controlled fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials.

Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions. A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission ( P = 0.02) and the length of hospital stay ( P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions. For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes. PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; CRD 42022363945.

Comparison of early aggressive versus nonaggressive fluid resuscitation in acute pancreatitis: a meta-analysis.

Early fluid resuscitation is one of the main therapeutic strategies for acute pancreatitis (AP). This study investigated the effects of early aggressive and nonaggressive hydration on AP. The aim of this meta-analysis is to investigate the differences between aggressive and nonaggressive intravenous fluid resuscitation in AP. This study was based on publicly available data, all of which have been extracted from previous ethically approved studies. Two authors systematically searched PubMed, Embase (via OVID), Web of Science, and Cochrane Library to find all published research before February 2023. In-hospital mortality were set as primary endpoints. This meta-analysis included seven randomized controlled trials (RCTs) and eight cohort studies with 4072 individuals in nonaggressive (n = 2419) and aggressive (n = 1653) hydration groups. The results showed that patients in the nonaggressive group had a lower mortality rate than those in the aggressive hydration group [relative risks (RR), 0.66; p = 0.02]. Subgroup analysis results showed that patients in the nonaggressive hydration group had lower mortality rates in RCTs (RR, 0.39; p = 0.001), studies conducted in Eastern countries (RR, 0.63; p = 0.002), and studies with severe pancreatitis (RR, 0.65; p = 0.02). In addition, the nonaggressive hydration group had lower rates of infection (RR, 0.62; p < 0.001), organ failure (RR, 0.65; p = 0.02), and shock (RR, 0.21; p = 0.02), as well as a shorter hospital stay (weighted mean difference, -1.63; p = 0.001) than the aggressive hydration group. Early nonaggressive fluid resuscitation is associated with lower mortality, lower risk of organ failure and infection, and shorter hospital stays than aggressive fluid resuscitation. CRD42023396388.

Landmark trial suggests aggressive fluid therapy in pancreatitis may cause more harm than good

Randomized controlled trials that investigate the optimal parameters of fluid resuscitation in acute pancreatitis—such as the rate of infusion or the total volume of fluid to be infused—remain scarce. However, the newly published WATERFALL trial, published on September 15, 2022, in the New England Journal of Medicine, sought to answer if current guidance is too aggressive.

Moderate Fluid Resuscitation Is Preferable in Acute Pancreatitis

de-Madaria J, Buxbaum JL, Maisonneuve P, et al. Aggressive or moderate fluid resuscitation in acute pancreatitis. N Engl J Med 2022;387:989–1000. Almost 1 in 3 patients presenting with acute pancreatitis progress to a moderate or severe form. Aggressive fluid resuscitation has been thought to improve perfusion, and thus outcomes, but the current literature is conflicting regarding the optimal fluid resuscitation strategy. The WATERFALL (Aggressive Versus Non-aggressive Goal-Directed Fluid Resuscitation in Acute Pancreatitis; NCT04381169) study originally planned to recruit 744 patients with mild acute pancreatitis whose symptoms had started less than 24 hours before and were diagnosed less than 8 hours before and randomize them to either aggressive or moderate fluid resuscitation (AFR or MFR) with lactated Ringer’s solution, an intravenous crystalloid with antiinflammatory properties. Those allocated to AFR received a 20-mL/kg fluid bolus followed by a 3-mL·kg−1·h−1 infusion, whereas those in the MFR group received a 10-ml/kg bolus (only if hypovolemic) followed by a 1.5-mL·kg−1·h−1 infusion. Fluid resuscitation was changed to goal-directed therapy after 12 hours, with patients with ongoing hypovolemia continuing with the strategies outlined above, while normovolemic patients received 1.5 mL·kg−1·h−1. Safety checkpoints were regularly undertaken, with fluids decreased or stopped in the event of fluid overload. The study was halted at the first planned interim safety analysis time point of 249 patients, having found no difference in the primary outcome—the development of moderately severe or severe pancreatitis—between AFR and MFR (22% vs 17%, adjuste relative risk [RR] 1.30, 95% confidence interval [CI] 0.78–2.18), but AFR was associated with higher rates of fluid overload (21% vs 6%, aRR 2.85, 95% CI 1.36–5.94). On average, patients in the AFR group received 7.8 L compared with 5.5 L in the MFR group. There were no differences in secondary outcomes such as organ failure, local complications, respiratory failure, necrotizing pancreatitis, intensive care unit admission, or length of hospitalization. The results were similar in prespecified subgroup analyses for patients with baseline hypovolemia or systemic inflammatory response syndrome. A study limitation was the exclusion of a large number of subjects who did not meet the relatively strict timelines for symptom duration or diagnosis (276 out of 676 screened patients, 41%). Thus, the results might not be applicable to the almost one-half of patients with acute pancreatitis who present late. In addition, the inability to meet the sample size as a result of the early termination could have affected the detection of differences in the measured outcomes. Nonetheless, the results of this trial support the use of MFR rather than AFR in patients with acute pancreatitis. Some questions regarding the optimal fluid resuscitation strategy in acute pancreatitis remain. For example, is Ringer’s the best solution? Should the fluid resuscitation be even more restrictive, especially if oral feeding is commenced early? Or would early aggressive fluid resuscitation for a short period be beneficial?

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis

BackgroundEarly aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited.MethodsAt 18 centers, we randomly assigned patients who presented with acute pancreatitis to receive goal-directed aggressive or moderate resuscitation with lactated Ringer’s solution. Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour in all patients in this group. Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to the patient’s clinical status. The primary outcome was the development of moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload. The planned sample size was 744, with a first planned interim analysis after the enrollment of 248 patients.ResultsA total of 249 patients were included in the interim analysis. The trial was halted owing to between-group differences in the safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; adjusted relative risk, 1.30; 95% confidence interval [CI], 0.78 to 2.18; P=0.32). Fluid overload developed in 20.5% of the patients who received aggressive resuscitation and in 6.3% of those who received moderate resuscitation (adjusted relative risk, 2.85; 95% CI, 1.36 to 5.94, P=0.004). The median duration of hospitalization was 6 days (interquartile range, 4 to 8) in the aggressive-resuscitation group and 5 days (interquartile range, 3 to 7) in the moderate-resuscitation group.ConclusionsIn this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes. (Funded by Instituto de Salud Carlos III and others; WATERFALL ClinicalTrials.gov number, NCT04381169.)

Impact of early aggressive fluid resuscitation in acute pancreatitis

Background/ObjectivesAcute pancreatitis management guidelines recommend early aggressive hydration to improve clinical outcomes. We aim to evaluate the influence of early fluid therapy (total intravenous fluids in the first 24 h [IVF/24hrs]) on clinical outcomes in patients with acute pancreatitis. MethodsThis was a retrospective chart review of all patients admitted for acute pancreatitis between July 2011 to December 2015. IVF/24hrs was categorized into 3 groups according to tertiles. Logistic regression was performed to evaluate predictors of persistent organ failure and in-hospital mortality. ResultsA total of 310 patients were included: Conservative (IVF/24hrs < 2.8L, n = 102), Moderate (IVF/24hrs 2.8–4.475L, n = 105) and Aggressive (IVF/24hrs ≥ 4.475, n = 103). Most patients (80.6%) were African Americans, 91.3% had mild acute pancreatitis (BISAP score ≤ 2). The Aggressive IVF group had higher incidence of persistent organ failure (16.5% vs 4.9% and 7.6%, p = 0.013), and longer length of hospital stay (9.2 ± 10.7 vs 6.5 ± 7.3 and 6.8 ± 5.7 days, P = 0.032). However, IVF/24hr did not correlate with length of hospital stay (PCC 0.08, p = 0.174). On multivariate analysis, only organ failure at admission was an independent predictor of persistent organ failure (OR 16.1, p < 0.001). Persistent organ failure and local complications were found to be the only independent predictors in-hospital mortality (OR 27.6, p < 0.001 and OR 16.95, p = 0.001 respectively). There was no difference in clinical outcomes in African Americans compared to other races. ConclusionsMore aggressive early IVF therapy in a predominantly mild acute pancreatitis cohort, was not associated with improvement in persistent organ failure, length of hospital stay, or in-hospital mortality.

S0020 The Effect of ER Crowding on Time to Fluid Initiation in Acute Pancreatitis

INTRODUCTION: Studies suggest that early fluid resuscitation in acute pancreatitis may improve outcomes. Thus, the timely diagnosis and treatment in the emergency room is vital. One factor consistently implicated in delay of care is ER crowding, which has been associated with increased inpatient mortality, longer hospital length of stay and higher healthcare costs. The primary aim of our study is to evaluate the effects of ER crowding on time to fluid initiation in patients who present to the emergency room with acute pancreatitis. METHODS: An observational cohort of consecutive unique patients who presented to the LAC + USC emergency room for acute pancreatitis between June 2015 and April 2017 were included. The time that the patient’s first set of vitals was recorded upon presentation to the emergency room triage was labeled as “time zero,” and the time that fluids were started was labeled as “time to fluid initiation.” The crowding level of the LAC + USC emergency room was determined by the National Emergency Department Overcrowding Scale (NEDOCS) at the time of patient presentation and was recorded on a scale from 1 to 4 (1 = normal, 2 = busy, 3 = overcrowded, 4 = severe). The primary endpoint was time to fluid initiation. Detailed demographic information, pancreatitis etiology, and medical history was recorded. Linear regression analysis to analyze the relationship between the crowding level to the time to fluid initiation. RESULTS: Overall, 42 patients presented when the ER had normal (level 1) crowding, 111 patients while it was busy (level 2), 119 patients while it was overcrowded (level 3) and 58 patients while it was (level 4) severely crowded. The features of the 330 patients stratified by crowding level was similar. Most of the patients in our study were of Hispanic ethnicity, 44% female, and 39% had comorbidities. Gallstone pancreatitis was the most common etiology. The time to fluid initiation was strongly correlated with ER crowding level and was significantly increased for each step increase in crowding (p < 0.001). It increased from 1.83 (±1.25 hours) in normal conditions to 2.78 (±2.5) hours when the ER was busy to 5.41 (±5) when overcrowded, and 7.1 (+6.8) when the condition was severe. CONCLUSION: ER overcrowding is strongly correlated with a delay in time to fluid initiation in patients with acute pancreatitis. Pathways to rapidly identify and trigger treatment are needed.Figure 1

Intravenous fluids in acute pancreatitis: a prospective study

Background: Fluid therapy is the mainstay of treatment in the management of acute pancreatitis. Most guidelines recommend aggressive fluid therapy in the initial 48-72 hours. We aimed to compare the occurrence, persistence or worsening of systemic inflammatory response syndrome (SIRS) and occurrence organ failure in patients with acute pancreatitis receiving normal and high volume fluid therapy in the first 24 hours.Methods: This was a prospective observational study. Consecutive adult patients admitted with acute pancreatitis were included in the study. SIRS was defined according to the criteria. Organ failure and local complications were defined according to Atlanta classification. Patients were divided into two groups according to the rate of fluid administered in the initial 24 hours: Normal volume group which received fluids at a rate &lt;150 ml/hour and high volume group &gt;150 ml/hour.Results: A total 60 patients were included in the study with 30 each in the two groups. Persistence or worsening of SIRS at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.076). Organ failure at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.074). Incidence of local complications equal in both group.Conclusions: Our study did not show any statistically significant difference in outcomes in patients with acute pancreatitis receiving normal or high volume fluids in the initial 24 hours. Further multi-centric randomised control trials are required to analyze the outcomes of high and normal volume fluid resuscitation in acute pancreatitis.

In-Service Education and Changes to the Electronic Health Record System Improve Intravenous Fluid Hydration in the Emergency Department in Patients With a Diagnosis of Acute Pancreatitis

According to ACG guidelines, initial management of acute pancreatitis includes aggressive hydration defined as 250-500 mL/hr of isotonic crystalloid solution. Based on literature, morbidity and mortality can be further reduced with early resuscitation of a bolus of at least 1 L followed by a rate of infusion at 250 mL/hr. The purpose of our study is to evaluate if providing education and including an option for infusions in an existing order set available to Emergency Department (ED) providers improves the adequacy of early fluid hydration in patients diagnosed with acute pancreatitis. Initially, we generated a list of adult patients who presented to the ED with acute pancreatitis during a 12 month period. A chart review was performed to obtain the demographic data, cause of pancreatitis, type and amount of bolus infusate, type and rate of infusion received in the ED and if there was a reason provided in the ED provider’s note when patients received less than 1L bolus and 250 mL/hr infusion. The results were presented to the ED providers. Barriers to giving adequate IV fluid hydration in the ED were identified. Changes were made to the electronic health record (EHR) system in the quick order section to include fluid infusion and in-service education about adequate fluid resuscitation in acute pancreatitis was provided to the ED providers. The study was then repeated over 7 months to detect an improvement. A total of 100 patients were diagnosed with acute pancreatitis in the ED in 12 months. Twenty eight percent of patients did not receive adequate fluid resuscitation (without medical explanation). After the in-service education was provided and change was made in the EHR system, 52 patients were diagnosed with acute pancreatitis in the ED in 7 months. Twenty one percent of patients did not receive adequate fluid resuscitation but two patients had a medical explanation for it. The proportion of patients receiving an inadequate bolus and infusion declined from 28% to 21%. Statistically this difference is not significant (test statistic of 0.937 vs critical value of 1.645). The proportion of patients receiving an inadequate infusion showed a significant decline from 85% to 50% (test statistic of 4.613). The proportion of patients receiving inadequate bolus increased from 23% to 38.5% (test statistic of 2.013). Based on our analysis, an unacceptably high percentage of patients are receiving inadequate fluid hydration in our ED. After in-service education was provided and changes were implemented in the EHR system, there was statistically significant improvement in the number of patients receiving adequate infusions but a decline in boluses that were given. This may suggest increased efficiency in navigating the EHR potentially made a more significant impact on outcomes than in-service education.

Intravenous fluid resuscitation in the management of acute pancreatitis.

In the absence of proven effective pharmacologic therapy in acute pancreatitis, and given its simplicity, wide availability, and perceived safety, intravenous fluid resuscitation remains the cornerstone in the early treatment of acute pancreatitis. Herein, we will review the rationale of fluid therapy, critically appraise the published literature, and summarize recent studies. Several observational studies and small clinical trials have raised concern about the efficacy and safety of aggressive fluid resuscitation. Early aggressive fluid therapy among acute pancreatitis patients with predicted mild severity appears to have the highest benefit, whereas aggressive resuscitation in patients with predicted severe disease might be futile and deleterious. Lactated Ringer's solution is the preferred fluid type based on animal studies, clinical trials, and meta-analyses. There is a wide variation of fluid resuscitation approaches in current guideline recommendations, quality indicators, and worldwide practice patterns. There is lack of high-quality data that supports the use of early aggressive fluid resuscitation. Large, well designed, multicenter randomized controlled trials are needed to determine the optimal timing, fluid type, volume, rate, and duration of fluid resuscitation in acute pancreatitis.

2816 Mortality of Different Etiologies of Acute Pancreatitis and Effect of Aggressive vs. Non-Aggressive Fluid Resuscitation

INTRODUCTION: Acute pancreatitis (AP) is a common cause of GI-related hospitalization. AP can be classified into mild AP, moderately severe AP and severe AP. Severe acute pancreatitis (SAP) and necrotizing pancreatitis (NP) or localized complications with infections account for &gt; 40% of pancreatitis related mortality. Common etiologies include acute biliary pancreatitis (ABP) and alcohol ( AAP). We aimed to study the mortality rate and effect of fluid resuscitation in AP (SAP, NP). METHODS: Patients with SAP and NP who received PEG-J were collected retrospectively from a single tertiary care center by utilizing ICD-9 and ICD-10 codes (International Classification of Diseases). Each case was confirmed by manual review. SAP and NP were defined per the 2012 revised Atlanta classification. Descriptive analysis was done by Excel. Fluid resuscitation was defined as aggressive hydration (AH) infusion of crystalloids given at a rate of at least 3.0 mL/kg/h after a bolus of 10-20 mL/kg within 24 hours of presentation. RESULTS: Seventy-nine patients with SAP or NP underwent PEG-J placement. Demographics, labs and comorbidities (Table 1). Etiologies of pancreatitis were alcohol 30% (24), biliary 39%, idiopathic 23%. Distribution based on Atlanta classification (Table 2). All-cause mortality of the patients was 12 (15%) and among this group 7 (9%) were related to pancreatitis related complications whereas 4 (5%) patients opted for palliative care and 1 was found to have pancreatic cancer. Among AAP, 4 patients died from reasons not related to pancreatitis, as compared to 4 patients (13%) who died in ABP group which were all related to pancreatitis. In ABP, 28 (90%) patients had data available for fluid. 8 (29%) received AH within first 24 hours and none of them died. 20 (71%) did not receive AH and 3 of them died. This was not significant at P &lt; 0.05 using Fisher exact test. In AAP, 21 (87.5%) had data for fluid. Six (29%) received AH and none of them died. Fifteen (71%) did not receive AH and 3 of them died but the deaths were not related to pancreatitis. Average ICU stay of the overall subjects was 8 days and median hospital stay was 12 days. Average duration of hospital stay in AAP was 19.8 days compared to 20.5 days in ABP. Average ICU stay was 9 days in both groups. CONCLUSION: ABP carries higher mortality and more LOS related to pancreatitis compared with AAP. The AH is associated with decreased mortality in ABP but was not statistically significant perhaps due to small sample size.

Early Aggressive Fluid Resuscitation in Acute Pancreatitis: Room for Debate?

Early Aggressive Fluid Resuscitation in Acute Pancreatitis: Room for Debate?

Response and outcome from fluid resuscitation in acute pancreatitis: a prospective cohort study

BackgroundIntravenous (IV) fluid resuscitation remains the cornerstone for early management of acute pancreatitis (AP), but many questions remain unanswered, including how to determine whether patients will benefit from additional fluids. The aim was to investigate the utility of serum biomarkers of responsiveness IV fluid resuscitation in patients with AP and systemic inflammatory response syndrome (SIRS). MethodsEligible adult patients had abdominal pain for <36 h and ≥2 SIRS criteria. Mean arterial pressure (>65 mmHg) and urine output (>0.5 ml/kg/h) were used to assess responsiveness at 2 and 6–8 h after initiation of IV fluids. Comparison was made between responsive and refractory patients at time points for fluid volume, biomarkers and outcomes. ResultsAt 2 h 19 patients responded to fluids (Group 1) while 4 were refractory (Group 2); at 6–8 h 14 responded (Group 3) and 9 were refractory (Group 4). No demographic differences between patient groups, but Group 4 had worse prognostic features than Group 3. Refractory patients received significantly more fluid (Group 4 mean 7082 ml vs. Group 3 5022 mL, P < 0.001) in first 24 h and had worse outcome. No significant differences in biomarkers between the groups. ConclusionsThe serum biomarkers did not discriminate between fluid responsive and refractory patients. Refractory patients at 6–8 h had more severe disease on admission, did not benefit from additional fluids and had a worse outcome. New approaches to guide fluid resuscitation in patients with AP are required.

Fluid resuscitation in acute pancreatitis.

Fluid resuscitation in acute pancreatitis.

An international multicenter study of early intravenous fluid administration and outcome in acute pancreatitis.

Early aggressive fluid resuscitation in acute pancreatitis is frequently recommended but its benefits remain unproven. The aim of this study was to determine the outcomes associated with early fluid volume administration in the emergency room (FVER) in patients with acute pancreatitis. A four-center retrospective cohort study of 1010 patients with acute pancreatitis was conducted. FVER was defined as any fluid administered from the time of arrival to the emergency room to 4 h after diagnosis of acute pancreatitis, and was divided into tertiles: nonaggressive (<500 ml), moderate (500 to 1000 ml), and aggressive (>1000 ml). Two hundred sixty-nine (26.6%), 427 (42.3%), and 314 (31.1%) patients received nonaggressive, moderate, and aggressive FVER respectively. Compared with the nonaggressive fluid group, the moderate group was associated with lower rates of local complications in univariable analysis, and interventions, both in univariable and multivariable analysis (adjusted odds ratio (95% confidence interval): 0.37 (0.14-0.98)). The aggressive resuscitation group was associated with a significantly lower need for interventions, both in univariable and multivariable analysis (adjusted odds ratio 0.21 (0.05-0.84)). Increasing fluid administration categories were associated with decreasing hospital stay in univariable analysis. Early moderate to aggressive FVER was associated with lower need for invasive interventions.

Fluid resuscitation with lactated Ringer's solution vs normal saline in acute pancreatitis: A triple-blind, randomized, controlled trial.

Little is known regarding the optimal type of fluid resuscitation in acute pancreatitis (AP). The objective of this article was to compare the effect of lactated Ringer's solution (LR) vs normal saline (NS) in the inflammatory response in AP. We conducted a triple-blind, randomized, controlled trial. Patients ≥ 18 admitted with AP were eligible. Patients were randomized to receive LR or NS. Primary outcome variables were number of systemic inflammatory response syndrome (SIRS) criteria at 24 hours, 48 hours and 72 hours and blood C-reactive protein (CRP) levels at 48 hours and 72 hours. Invitro complementary experiments were performed to further explore the interaction between pH, lactate and inflammation. Nineteen patients receiving LR and 21 receiving NS were analyzed. The median (p25-p75) number of SIRS criteria at 48 hours were 1 (1-2) for NS vs 1 (0-1) for LR, p = 0.060. CRP levels (mg/l) were as follows: at 48 hours NS 166 (78-281) vs LR 28 (3-124), p = 0.037; at 72 hours NS 217 (59-323) vs LR 25 (3-169), p = 0.043. Invitro, LR inhibited the induction of inflammatory phenotype of macrophages and NF-κB activation. This effect was not observed when using Ringer's solution without lactate, suggesting a direct anti-inflammatory effect of lactate. Lactated Ringer's is associated with an anti-inflammatory effect in patients with acute pancreatitis.

Sa1349 - Targeted Early Aggressive Fluid Resuscitation in Acute Pancreatitis: A Propensity Score Matched Analysis

Sa1349 - Targeted Early Aggressive Fluid Resuscitation in Acute Pancreatitis: A Propensity Score Matched Analysis

293 Lactated Ringers Solution Versus Normal Saline for Fluid Resuscitation in Acute Pancreatitis, a Randomized Controlled Trial

293 Lactated Ringers Solution Versus Normal Saline for Fluid Resuscitation in Acute Pancreatitis, a Randomized Controlled Trial