Early Crystalloid Fluid Volume Management in Acute Pancreatitis: Association with Mortality and Organ Failure

Clinical pathways for acute pancreatitis: Recommendations for early multidisciplinary management

“…However, both excessive rehydration and the scarce supply of fluids in the first 48 h are associated with an increased morbidity and mortality. 29 In addition, a greater need of fluids associated with oliguria 30 is a sign of alarm and consequently requires greater and continuous hemodynamic control 31,32 or even the employment of vasopressor drugs in accordance with the initial severity. 29 Oxygenation is needed for adjusting the saturation >95% in severe and critical AP.…”

“…29 In addition, a greater need of fluids associated with oliguria 30 is a sign of alarm and consequently requires greater and continuous hemodynamic control 31,32 or even the employment of vasopressor drugs in accordance with the initial severity. 29 Oxygenation is needed for adjusting the saturation >95% in severe and critical AP. 33 41 Percutaneous catheter drainage guided by ultrasound or CT is useful for managing infected fluid collections or necrosis and also as a part of the step-up approach.…”

Fluid Replacement Strategy in Severe Acute Pancreatitis

“…Finally, an Italian survey on the treatment of acute pancreatitis [18] assessed the compliance of 56 medical and surgical centers equally distributed throughout Italy with the Italian guidelines on acute pancreatitis [19]. The severity of the disease was clinically assessed according to the Atlanta criteria [20]; the majority of patients was observed and treated early after the onset of acute pancreatitis with an interval between the onset of pain and hospital admission of 15 hours for patients with mild acute pancreatitis and 18 hours for those having severe pancreatitis. In these patients the amount of fluids administered during the first 72 hours was significantly higher in patients with severe acute pancreatitis than in those with the mild form.…”

“…Regarding the question as to what the adequate volume of fluid needed by patients is and when it should be administered, Kuwabara et al [20] revised the data of 9,489 acute pancreatitis patients 18 years of age or older who were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. They analyzed the Fluid Volume (FV) administered during the initial 48 hours (FV48) and during hospitalization (FVH), and calculated the FV ratio (FVR) as FV48/ FVH.…”

Current Controversies in Fluid Resuscitation in Acute Pancreatitis

“…However, a relative increase in fluid volume during the initial 48 hours compared with the fluid received throughout hospitalization correlated with decreased mortality. 72 The preliminary reports from a very recent prospective cohort study involving 247 patients concluded that administration of more than 4.1 L during the initial 24 hour was significantly and independently associated with persistent organ failure, acute collections, and respiratory and renal insufficiency. They also reported that less than 3.1 L during the initial 24 hours was not associated with organ failure, local complications, or mortality in their preliminary observations.…”